208-OR: Impact of Carbohydrate-Restricted Nutrition Therapy and Continuous Remote Care among People with Type 2 Diabetes in Rural vs. Urban Areas (2024)

Diabetes outcomes and complications are often worse in rural (R) versus urban (U) areas, commonly due to challenges accessing health services. Our telemedicine clinic aims to address these barriers, offering carbohydrate-restricted nutrition therapy via continuous remote care for people with type 2 diabetes (T2D) nationwide. This retrospective analysis assessed the 1 year (y) effects of this care model on cardiometabolic markers in people with T2D from R and U counties. 74.7% R and 74.1% U were enrolled at least 1y in the clinic at time of analysis; a random sample of 800 was identified from each cohort. Changes from enrollment (E) to 1y were assessed with linear mixed effect models or logistic regression, as appropriate. Characteristics at E were consistent between R and U (Table 1). No differences between R and U areas were observed (ps>0.05). In both R and U at 1y, HbA1c, weight, HDL-C, triglycerides, and liver enzymes improved, total cholesterol was unchanged, and LDL-C slightly increased within normal limits. There was no difference between R and U in attainment of HbA1c <8% and LDL-C <100 mg/dL at E and 1y. Patients in R areas were 20% less likely [OR: 0.80 (0.64, 0.99), p=0.04] to attain TG<150 mg/dL vs U at E, but after 1 y, this disparity was closed [OR: 0.85(0.67, 1.08)]. These results show that this care model improves real-world cardiometabolic health in T2D in R and U areas.