1394-P: One-Year Effectiveness of Carbohydrate-Restricted Nutrition Therapy in Individuals with Prediabetes in Rural vs. Urban Areas

Availability of diabetes prevention programs is largely limited to urban (U) areas, posing a challenge to diabetes prevention in rural (R) areas. Virta Health provides carbohydrate-restricted nutrition therapy (CRNT) through continuous remote care (CRC) and has been implemented nationwide to prevent progression of prediabetes (preD). In this retrospective analysis, we aim to assess the 1-year effect of the program on cardiometabolic markers in individuals with preD from both R and U counties. A random sample of individuals with preD who remained in the program at least 1y was selected (250 from R areas and 250 from U areas). Changes in metabolic markers from enrollment (E) to 1y were assessed in a linear mixed effect model. Characteristics at E were consistent between the R and U cohorts (age=50.9 (9.4)y, BMI= 36.7 (7.7)kg/m2, HbA1c=5.8(0.3)%). HbA1c [-0.2% from E:5.7±0.0 (R), -0.2% from E: 5.8±0.0 (U); ps<0.001], weight [-9.2% from E:231.3±1.3 (R), -9.2% from E: 231.4±1.3 (U); ps<0.001], HDL-C [13.3% from E:49.5±0.6 (R), 13.1% from E:50.2±0.6 (U); ps<0.001], TG [-24.3% from E:152.2±4.2 (R), -26.9% from E:137.4±4.2 (U); ps<0.001] improved, with no differences between R and U areas. Liver enzymes [ALT at E: 28.4±0.9(R), 27.6±0.9(U) U/L; ALP at E: 79.4±1.3(R), 76.5±1.3(U) U/L ] were within normal limits and significantly decreased [ALT:-11.2% (R), -11.5%(U); ALP: -5.7% (R), -5.8% (U); ps<0.001]. Total cholesterol, LDL-cholesterol, and AST were unchanged. Individuals with preD in both R and U settings showed similar improvements in weight, HbA1c, and cardiometabolic markers. These findings demonstrate the effectiveness of this care model in improving cardiometabolic risk markers in people with preD living in both R and U areas.