We previously showed that a digitally-monitored continuous care intervention (CCI) including nutritional ketosis (NK) substantially improved weight and HbA1c in adults with T2D. In this intervention, health coaches provided personalized nutrition guidance informed by biomarker data participants entered into a mobile app. Here, we examined whether indicators of early treatment engagement (i.e., messaging coaches, logging biomarkers, achieving NK) predicted the decreases in weight and HbA1c at 1 and 2 years. 262 adults with T2D (mean age=54 years, 67% female, mean HbA1c %=7.6, 92% obese) in the CCI were counseled to eat a whole foods very low carbohydrate diet. The percentage of days participants messaged their coach and logged ≥1 biomarker or symptom, and percentage of blood beta-hydroxybutyrate (BHB) readings ≥0.5 mM (indicating NK) during the first 10 weeks were obtained from the app. Weight and HbA1c were measured in clinic. We conducted correlation and GLM intent-to-treat analyses to assess relations between measures of treatment engagement and percent change in weight and HbA1c from baseline to 1 and 2 years. Coach messaging and logging were not correlated with percent change in weight or HbA1c; however, a greater percentage of BHB readings ≥0.5 was correlated with a greater percent decrease in weight (r=-0.25, p=0.001) and HbA1c (r=-0.19, p=0.004) from baseline to 1 year (but not 2 years). In GLM analyses, a greater percentage of BHB readings ≥0.5 predicted greater percent decrease in weight (b=-0.06, p=0.01) and HbA1c (b=-0.06, p=0.03) at 1 year after accounting for coach messaging, logging, and baseline demographic and medical characteristics. Results indicate that greater adherence to NK during the first 10 weeks explained a significant proportion of the variance in weight loss and A1c reduction, whereas simple app-based engagement did not. Future analyses should explore the role of maintaining NK over the remainder of the year on 1 year outcomes.
R.N. Adams: Employee; Self; Virta Health Corp. A. McKenzie: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. S.J. Athinarayanan: Employee; Self; Virta Health Corp. S. Hallberg: Advisory Panel; Self; Atkins Nutritionals, Inc. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. J.P. McCarter: Employee; Self; Virta Health Corp. S. Phinney: Advisory Panel; Self; Atkins Nutritionals, Inc. Board Member; Self; Virta Health Corp. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. Other Relationship; Self; Beyond Obesity.