Background: We previously observed that adherence to carbohydrate restriction (CR) nutrition therapy during the first 3 months of a continuous remote care intervention predicted 1-yr improvements in weight and HbA1c in adults with T2D. However, the extent to which ongoing CR is needed to sustain health improvements is unknown.

Methods: 262 adults with T2D counseled on CR reported adherence measured by blood beta-hydroxybutyrate (BHB) regularly via a mobile app. Patients enrolled 1-yr with mean BHB ≥0.3 mM in the first 3 months (n=174) were split into quartiles based on the percent of BHB logs ≥ 0.3 and 0.5 mM during months 4 through 12. We conducted ANOVAs to compare the groups’ percent change in weight and HbA1c from baseline to 1-yr.

Results: All groups had clinically significant improvements on average in weight and HbA1c, but the percent change statistically differed by group (Ps<0.01). Participants who reported CR more often had greater benefit at 1-yr (Table 1). Using a 0.3 mM BHB cut-off, very consistent restriction (≥95% of the time) yielded significantly greater benefit. A 0.5 mM cut-off demonstrated greater benefit with lower frequencies of reporting (≥38% for weight and ≥66% for HbA1c).

Discussion: More frequent CR over the remainder of the year conferred greater benefit on health outcomes. Future analyses should carefully examine whether the pattern of BHB values over time influences outcomes.


R.N. Adams: Employee; Self; Virta Health Corp. S.J. Athinarayanan: Employee; Self; Virta Health Corp. S. Phinney: Advisory Panel; Self; Atkins Nutritionals, Inc. Stock/Shareholder; Self; Beyond Obesity LLC (publishing), Virta Health Corp. A. McKenzie: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp.

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