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. 2024 Mar;26(3):1016-1022.
doi: 10.1111/dom.15401. Epub 2023 Dec 11.

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

Kiersten L Strombotne  1   2 , Jessica Lum  2 , Steven D Pizer  1   2 , Stuart Figueroa  1   2 , Austin B Frakt  1   2   3 , Paul R Conlin  2   4
Affiliations

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

Kiersten L Strombotne et al. Diabetes Obes Metab. 2024 Mar.

Abstract

Aim: We previously evaluated the impacts at 5 months of a digitally delivered coaching intervention in which participants are instructed to adhere to a very low carbohydrate, ketogenic diet. With extended follow-up (24 months), we assessed the longer-term effects of this intervention on changes in clinical outcomes, health care utilization and costs associated with outpatient, inpatient and emergency department use in the Veterans Health Administration.

Materials and methods: We employed a difference-in-differences model with a waiting list control group to estimate the 24-month change in glycated haemoglobin, body mass index, blood pressure, prescription medication use, health care utilization rates and associated costs. The analysis included 550 people with type 2 diabetes who were overweight or obese and enrolled in the Veterans Health Administration for health care. Data were obtained from electronic health records from 2018 to 2021.

Results: The virtual coaching and ketogenic diet intervention was associated with significant reductions in body mass index [-1.56 (SE 0.390)] and total monthly diabetes medication usage [-0.35 (SE 0.054)]. No statistically significant differences in glycated haemoglobin, blood pressure, outpatient visits, inpatient visits, or emergency department visits were observed. The intervention was associated with reductions in per-patient, per-month outpatient spending [-USD286.80 (SE 97.175)] and prescription drug costs (-USD105.40 (SE 30.332)].

Conclusions: A virtual coaching intervention with a ketogenic diet component offered modest effects on clinical and cost parameters in people with type 2 diabetes and with obesity or overweight. Health care systems should develop methods to assess participant progress and engagement over time if they adopt such interventions, to ensure continued patient engagement and goal achievement.

Keywords: dietary intervention; health economics; real-world evidence; type 2 diabetes.

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Conflict of interest statement

Conflicts of Interest Disclosures

The authors have no potential conflicts of interest relevant to this article to disclose. The views expressed in this paper are those of the authors and do not necessarily reflect the position or policy of the VA, Veterans Health Administration (VHA), or the U.S. Government.

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