A very low carbohydrate diet with nutritional ketosis (NK) improves HbA1c, weight, and atherogenic dyslipidemia in people with type 2 diabetes (T2D), but effects of degree and duration of NK sustained on outcomes are unknown. Hemoglobin A1c, weight, triglycerides, and HDL-C among people with T2D who received a NK intervention via continuous telemedicine care (CC; n=262) or usual care without carbohydrate restriction (UC; n=87) over two years were assessed. Latent class trajectory modeling identified four ketosis trajectory groups within the CC. Annual change in these markers were compared among the CC groups and UC as reference using a linear mixed effects model. A dose-response relationship between the concentration of blood ketones (proxy for degree of carbohydrate restriction) and duration of NK maintenance was observed (Table 1), where the group with sustained NK of ~1mM maintained the greatest improvements. Changes in weight and HbA1c were observed with low NK (0.3-0.4mM), though continued improvements in atherogenic dyslipidemia required greater degrees of sustained NK (~0.7 followed by 0.5mM). These results inform clinical practice, showing that improvement in HbA1c and weight can occur with modest NK, though greater and broader improvements occur with moderate NK of ~0.7-0.5mM, and optimal outcomes occur with consistently sustained NK of ~1mM.


A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.J.Athinarayanan: Employee; Virta Health Corp. C.G.P.Roberts: Employee; Virta Health Corp. R.N.Adams: Employee; Virta Health Corp. B.M.Volk: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.D.Phinney: Board Member; Virta Health Corp., Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. J.Volek: Stock/Shareholder; Virta Health Corp.


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