Effectiveness of a ketogenic diet and virtual coaching intervention for patients with diabetes: A difference‐in‐differences analysis

Abstract

Aim To test the effectiveness of a ketogenic diet and virtual coaching intervention in controlling markers of diabetes care and healthcare utilization. Materials and Methods Using a difference‐in‐differences analysis with a waiting list control group—a quasi‐experimental methodology—we estimated the 5‐month change in HbA1c, body mass index, blood pressure, prescription medication use and costs, as well as healthcare utilization. The analysis included 590 patients with diabetes who were also overweight or obese, and who regularly utilize the Veterans Health Administration (VA) for healthcare. We used data from VA electronic health records from 2018 to 2020. Results The ketogenic diet and virtual coaching intervention was associated with significant reductions in HbA1c (−0.69 [95% CI −1.02, −0.36]), diabetes medication fills (−0.38, [−0.49, −0.26]), body mass index (−1.07, [−1.95, −0.19]), diastolic blood pressure levels (−1.43, [−2.72, −0.14]), outpatient visits (−0.36, [−0.70, −0.02]) and prescription drug costs (−34.54 [−48.56, −20.53]). We found no significant change in emergency department visits (−0.02 [−0.05, 0.01]) or inpatient admissions (−0.01 [−0.02, 0.01]). Conclusions This real‐world assessment of a virtual coaching and diet programme shows that such an intervention offers short‐term benefits on markers of diabetes care and healthcare utilization in patients with diabetes.

Clinical effectiveness and cost‐impact after 2 years of a ketogenic diet and virtual coaching intervention for patients with diabetes

“…An initial evaluation of the impact of the programme was conducted at a 5-month follow-up interval. 12 The present study extends the follow-up to 24 months. During that period, 40 patients who were initially on the wait list were offered access to the programme.…”

“…An initial evaluation of the impact of the programme was conducted at a 5‐month follow‐up interval 12 . The present study extends the follow‐up to 24 months.…”

“…Virtual dietary coaching programmes have been proposed as interventions for short-term weight loss and improving glucose levels in patients with DM. [3][4][5][6][7][8][9][10][11][12] While reduced calorie diets per se are the mainstay of weight-loss programmes, some have suggested that coaching programmes that include a carbohydrate-reduced diet, which produces mild ketosis, may facilitate tapering DM medications. 13 Despite these claims, there is limited evidence that ketogenic-focused, virtual coaching programmes can sustain clinical effectiveness beyond a relatively short timeframe.…”

“…Virtual dietary coaching programmes have been proposed as interventions for short‐term weight loss and improving glucose levels in patients with DM 3–12 . While reduced calorie diets per se are the mainstay of weight‐loss programmes, some have suggested that coaching programmes that include a carbohydrate‐reduced diet, which produces mild ketosis, may facilitate tapering DM medications 13 .…”

“…We evaluated 2‐year outcomes among Veterans enrolled in a digitally delivered coaching intervention in which participants are encouraged to adhere to a very low carbohydrate, ketogenic nutrition programme (Virta Health). In a previous report we observed significant changes in clinical outcomes after 5 months of the intervention 12 . To determine if changes are sustained for 2 years after programme initiation, we employed a quasi‐experimental design to evaluate clinical outcomes, health care utilization and costs associated with pharmacy, outpatient, inpatient and emergency department (ED) use.…”