Introduction and Objective: Midlife women often experience worsening glycemia and a BMI rise of ~1-2 kg/m² over the years during the peri- and post-menopausal transition, although estrogen therapy may attenuate this trend. Whether dietary interventions can counter these trends in real-world settings is unclear. We evaluated 1-year BMI, weight, and HbA1c trajectories among women aged ≥45 with type 2 diabetes who remained in a digital carbohydrate-reduced nutrition program for at least 1 year and examined whether estrogen (Est) therapy modified outcomes. Methods: All Est users (n=118) were retained, and 880 non-users were selected using stratified random sampling to preserve the enrollment (E) age, BMI and HbA1c distribution observed in Est users (Table 1 for descriptives). Outcomes at E, 6, and 12 months were analyzed using linear mixed-effects models with a time×Est interaction (T*Est); category shifts were assessed using the Stuart-Maxwell test. Results: BMI declined from 33.84 to 30.70, HbA1c from 7.24% to 6.56%, and weight from 200.19 to 181.57 lb, all significantly, with no significant T*Est. BMI and HbA1c categories shifted significantly toward healthier, lower-risk classifications (p0.001; Table 1), demonstrating broad metabolic improvement. Conclusion: These findings contrast with expected upward BMI trajectories in midlife women and suggest carbohydrate reduction may meaningfully mitigate metabolic deterioration during menopause, independent of estrogen use. Disclosure S.J. Athinarayanan: Employee; Current; Virta Health Corp. Stock/Shareholder; Current; Virta Health Corp. C.G. Roberts: Employee; Current; Virta Health Corp. Stock/Shareholder; Current; Virta Health Corp. Advisory Panel; Current; Coalition for Metabolic Health. A. Zoller: Employee; Current; Virta Health Corp. R.N. Adams: Employee; Current; Virta Health Corp. Stock/Shareholder; Current; Virta Health Corp.
ATHINARAYANAN et al. (Fri,) studied this question.