132-OR: Structured Medical Nutrition Therapy Improves Glycemia, Reduces Percentage Body Fat while Maintaining Fat-Free Mass in Individuals with Overweight/Obesity and Type 2 Diabetes

Recently approved long-acting GLP-1 based therapies are effective in glycemic control and weight loss. However, they reduce fat free mass (FFM), a surrogate for muscle mass. We previously showed that structured medical nutrition therapy (SMNT) also improves glycemia but its effect on FFM is unknown. This is a sub-analysis of a clinical trial where 108 individuals with type 2 diabetes (T2D) and overweight/obesity (age 60±10 years; 57% female; HbA1c 8.07±1.05%; weight 101.4±21.1kg and BMI 35.2±7.7kg/m²) were randomized to 3 groups. Group A met with a registered dietitian (RD) to develop individualized meal plans. Group B & C met with RD and followed an isocaloric SMNT plan that included specific menus and diabetes-specific nutrition formula targeting a total daily protein intake of 1-1.5 gm/kg of adjusted body weight. Group C received additional weekly RD phone support. Body composition was evaluated using bioelectrical impedance. After 16 weeks, A1C did not change in group A but decreased in groups B (-0.66%, 95% CI -1.03 to -0.30) and C (-0.61%, 95% CI -1.0 to -0.23), p <0.001 between groups over time. Weight change was not different between groups. Percentage body fat did not change in group A but decreased in groups B (−1.6%, 95% CI −2.4 to −0.8) and C (−1.2%, 95% CI −2 to−0.3), p <0.05 between groups over time. All groups had no change in FFM. While protein intake was similar between groups at baseline, only groups B & C increased their % energy intake from protein by 4.8% (95% CI 2.8 to 6.8) and 4.2% (95% CI 2.1 to 6.2) respectively, p <0.001 between groups over time. These data suggest that SMNT improves glycemia and reduces % body fat while maintaining FFM compared to individualized meal plans. These changes are likely attributed to increased % energy intake from protein. Further studies are needed to evaluate if SMNT mitigates FFM loss in individuals with overweight/obesity and T2D treated with GLP-1 based therapies.