Evaluating the impact of a virtual healthcare provider-led nutrition-based type 2 diabetes remission intervention on glycemic management and medication use

INTRODUCTION: Emerging evidence indicates that remission of type 2 diabetes (T2D) is achievable through nutritional approaches. However, effectiveness of remission-focused nutrition interventions has yet to be tested in real-world settings. OBJECTIVE: To evaluate the preliminary effectiveness of a virtual healthcare provider-led nutrition intervention for T2D remission on glycemic management and medication use. METHODS: This quasi-experimental study was remotely delivered by registered dietitians and pharmacists. Adults with T2D self-selected to either a 12-week whole-food ketogenic diet (KD, <50g of carbohydrates/day) or a low-calorie, low-carbohydrate commercial weight-loss diet (LCAL, 900-1100 kcal/day). Continuous glucose monitoring (CGM) was used to assess glycemic outcomes at baseline, weeks 1-2, and weeks 13-14. The primary outcome was change in CGM-derived average glucose for the overall cohort. Secondary outcomes included additional CGM metrics and medication effect score (MES), which reflects glucose-lowering medication intensity. Exploratory analyses examined within-diet changes and between-group differences. RESULTS: The majority of participants (n=59) selected the KD compared to the LCAL diet (n=21). Overall, there were significant improvements in almost all CGM metrics, in the cohort as a whole and within each group, at both weeks 1-2 and weeks 13-14. This included reductions in average glucose, coefficient of variation (CV%), SD, and time above range (TAR), along with significant increases in time in range (TIR) and time in tight range (TITR) (all p<0.01). Time below range (TBR) remained unchanged throughout the intervention, suggesting no increased risk of hypoglycemia. In exploratory between-group analyses, the only significant difference detected was for TITR, which was higher in the LCAL group. Glucose-lowering medications decreased significantly, with MES reduced by -0.7 (arbitrary units; 95% CI, -0.9, -0.5) at 12 weeks for the overall cohort. Total self-reported daily energy intake decreased significantly in the LCAL group at week 12 compared with baseline (p=0.012) but did not change significantly in the KD group (p>0.05). Carbohydrate intake decreased significantly in both groups (both p<0.05). CONCLUSIONS: A virtual, healthcare provider-led, nutrition-based T2D remission intervention led to significant improvements in CGM-derived glycemic outcomes and reduced medication burden over 12 weeks, supporting the preliminary effectiveness and safety of remotely-delivered nutritional strategies for T2D management.