Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study.

Autor: Hallberg SJ; Medically Supervised Weight Loss, Indiana University Health Arnett, Lafayette, IN, USA.; Virta Health, San Francisco, CA, USA., McKenzie AL; Virta Health, San Francisco, CA, USA. amy@virtahealth.com., Williams PT; Independent Consultant, Lafayette, CA, USA., Bhanpuri NH; Virta Health, San Francisco, CA, USA., Peters AL; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA., Campbell WW; Department of Nutrition Science, Purdue University, West Lafayette, IN, USA., Hazbun TL; Medically Supervised Weight Loss, Indiana University Health Arnett, Lafayette, IN, USA., Volk BM; Virta Health, San Francisco, CA, USA., McCarter JP; Virta Health, San Francisco, CA, USA.; Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA., Phinney SD; Virta Health, San Francisco, CA, USA., Volek JS; Virta Health, San Francisco, CA, USA.; Department of Human Sciences, The Ohio State University, Columbus, OH, USA.
Jazyk: angličtina
Zdroj: Diabetes therapy : research, treatment and education of diabetes and related disorders [Diabetes Ther] 2018 Apr; Vol. 9 (2), pp. 583-612. Date of Electronic Publication: 2018 Feb 07.
DOI: 10.1007/s13300-018-0373-9
Abstrakt: Introduction: Carbohydrate restriction markedly improves glycemic control in patients with type 2 diabetes (T2D) but necessitates prompt medication changes. Therefore, we assessed the effectiveness and safety of a novel care model providing continuous remote care with medication management based on biometric feedback combined with the metabolic approach of nutritional ketosis for T2D management.
Methods: We conducted an open-label, non-randomized, controlled, before-and-after 1-year study of this continuous care intervention (CCI) and usual care (UC). Primary outcomes were glycosylated hemoglobin (HbA 1c ), weight, and medication use. Secondary outcomes included fasting serum glucose and insulin, HOMA-IR, blood lipids and lipoproteins, liver and kidney function markers, and high-sensitivity C-reactive protein (hsCRP).
Results: 349 adults with T2D enrolled: CCI: n = 262 [mean (SD); 54 (8) years, 116.5 (25.9) kg, 40.4 (8.8) kg m 2 , 92% obese, 88% prescribed T2D medication]; UC: n = 87 (52 (10) years, 105.6 (22.15) kg, 36.72 (7.26) kg m 2 , 82% obese, 87% prescribed T2D medication]. 218 participants (83%) remained enrolled in the CCI at 1 year. Intention-to-treat analysis of the CCI (mean ± SE) revealed HbA 1c declined from 59.6 ± 1.0 to 45.2 ± 0.8 mmol mol -1 (7.6 ± 0.09% to 6.3 ± 0.07%, P < 1.0 × 10 -16 ), weight declined 13.8 ± 0.71 kg (P < 1.0 × 10 -16 ), and T2D medication prescription other than metformin declined from 56.9 ± 3.1% to 29.7 ± 3.0% (P < 1.0 × 10 -16 ). Insulin therapy was reduced or eliminated in 94% of users; sulfonylureas were entirely eliminated in the CCI. No adverse events were attributed to the CCI. Additional CCI 1-year effects were HOMA-IR - 55% (P = 3.2 × 10 -5 ), hsCRP - 39% (P < 1.0 × 10 -16 ), triglycerides - 24% (P < 1.0 × 10 -16 ), HDL-cholesterol + 18% (P < 1.0 × 10 -16 ), and LDL-cholesterol + 10% (P = 5.1 × 10 -5 ); serum creatinine and liver enzymes (ALT, AST, and ALP) declined (P ≤ 0.0001), and apolipoprotein B was unchanged (P = 0.37). UC participants had no significant changes in biomarkers or T2D medication prescription at 1 year.
Conclusions: These results demonstrate that a novel metabolic and continuous remote care model can support adults with T2D to safely improve HbA 1c , weight, and other biomarkers while reducing diabetes medication use. CLINICALTRIALS.
Gov Identifier: NCT02519309.
Funding: Virta Health Corp.
Databáze: MEDLINE
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