Five-Year outcomes of a digitally delivered carbohydrate-reduced nutrition intervention for prediabetes: durability of diabetes prevention

Introduction Sustained prevention of type 2 diabetes (T2D) remains a major public health challenge, as benefits from traditional lifestyle and earlier pharmacologic interventions have often been difficult to maintain. Prediabetes is associated with increased cardiometabolic disease risk and mortality even without progression to diabetes. Interventions that achieve long-term metabolic health improvements are needed. This study reports five-year outcomes of a continuous remote care intervention (CCI) delivering individualized carbohydrate-reduced nutrition therapy in adults with prediabetes. Methods A three-year prospective, single-arm longitudinal study extended a previously reported two-year trial ( ClinicalTrials.gov NCT02519309). Adults 21–65 years with prediabetes were enrolled ( n = 96) in the original two-year trial; 58 participants consented to a three-year extension. Outcomes assessed over 5 years included glycemic status, weight, insulin resistance, lipids, inflammatory markers, and liver and kidney function. Longitudinal changes were analyzed using generalized estimating equations and linear mixed-effects models as part of an extension cohort analysis. Results At five years, 45 participants (47% of the original cohort) completed follow-up with 22% achieving normoglycemia ( P < 0.001), and 13% progressing to T2D ( P < 0.01). The cumulative incidence (i.e., achievement at any time point) of regression to normoglycemia was 55.6%, and progression to T2D was 12.2% over five years. Fasting insulin, HOMA-IR, triglycerides, HDL-C, LDL-C, non-HDL-C, and hsCRP were maintained at or below baseline levels at five years; however, these differences were not statistically significant after adjustment, despite unadjusted P -values ≤ 0.05. Mean body weight was reduced by 5.8 kg (5.3%; P < 0.001), with 47%, 29%, and 13% achieving ≥5%, ≥10%, and ≥15% weight loss, respectively. Liver and kidney function was stable. Conclusion Participation in a continuous remote care model delivering individualized carbohydrate-reduced nutrition therapy was associated with significant weight reduction and maintenance of glycemic status, insulin resistance, and cardiometabolic risk markers over five years among adults with prediabetes. Although mean glycemic markers were comparable to baseline at five years, a substantial proportion of participants achieved normoglycemia and relatively few progressed to T2D, suggesting potential for long-term diabetes prevention with a digitally supported, nutrition-focused intervention.