Background: People with prediabetes are more likely to suffer from poor sleep, and sleep characteristics are correlated with metabolic markers such as glycemia and weight. We previously reported 1-yr improvements in sleep and metabolic health among people with prediabetes participating in a very low carb intervention including nutritional ketosis delivered via continuous remote care. Improvements in metabolic health were also observed out to 5 yrs. Given the relationships between sleep and metabolic health, in this analysis we explored whether sleep characteristics that improved at 1 yr were also improved at 5 yrs.

Methods: Adults with prediabetes initially enrolled in a 2-yr single-arm trial were offered to continue for 3 more yrs of prospective follow-up. Of the 72 participants completing 2 yrs, 58 (81%) of participants consented to the extension and 45 (78%) were retained at 5 yrs. Baseline characteristics of those who extended include: 83% female, mean age= 53 yrs, mean HbA1c = 5.9%, and mean BMI= 39. Sleep was assessed with the Pittsburgh Sleep Quality Index at baseline, 3 mos, 1 yr, 2 yrs, 3.5 yrs, and 5 yrs. Among all extending participants, we explored changes over time in Global Sleep, Sleep Quality, Sleep Disturbances, and Daytime Dysfunction using 4 linear mixed effects models (intent-to-treat analyses) controlling for age, gender, and race.

Results: The overall effect of time was significant for all sleep measures, such that sleep improved over time (ps <0.02). From baseline to 5 yrs, sleep score improvements ranged from 21-28% (ps <0.02).

Conclusions: Participants in a virtual nutrition therapy intervention focused on nutritional ketosis reported long-term improvements in sleep out to 5 yrs concurrent with sustained metabolic health improvements. This provides additional evidence that this intervention benefits overall health. Additional research is needed to better understand what drove perceptions of sleep improvement.


R. N. Adams: Employee; Virta Health Corp. S. J. Athinarayanan: Employee; Virta Health Corp. B. M. Volk: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp. S. D. Phinney: Stock/Shareholder; Virta Health Corp. Board Member; Virta Health Corp. Employee; Virta Health Corp. J. Volek: Stock/Shareholder; Virta Health Corp. A. L. McKenzie: Employee; Virta Health Corp. Stock/Shareholder; Virta Health Corp.

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