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LB: PSYCHOSOCIAL, BEHAVIORAL MEDICINE| JUNE 20 2023


Sleep Improves over Five Years of Very Low Carbohydrate Nutrition Therapy for Prediabetes Delivered by Continuous Remote Care
REBECCA N. ADAMS; SHAMINIE J. ATHINARAYANAN; BRITTANIE M. VOLK; STEPHEN D. PHINNEY; JEFF VOLEK; AMY L. MCKENZIE

Background: People with prediabetes are more likely to suffer from poor sleep, and sleep characteristics are correlated with metabolic markers such as glycemia and weight. We previously reported 1-yr improvements in sleep and metabolic health among people with prediabetes participating in a very low carb intervention including nutritional ketosis delivered via continuous remote care. Improvements in metabolic health were also observed out to 5 yrs. Given the relationships between sleep and metabolic health, in this analysis we explored whether sleep characteristics that improved at 1 yr were also improved at 5 yrs.

Methods: Adults with prediabetes initially enrolled in a 2-yr single-arm trial were offered to continue for 3 more yrs of prospective follow-up. Of the 72 participants completing 2 yrs, 58 (81%) of participants consented to the extension and 45 (78%) were retained at 5 yrs. Baseline characteristics of those who extended include: 83% female, mean age= 53 yrs, mean HbA1c = 5.9%, and mean BMI= 39. Sleep was assessed with the Pittsburgh Sleep Quality Index at baseline, 3 mos, 1 yr, 2 yrs, 3.5 yrs, and 5 yrs. Among all extending participants, we explored changes over time in Global Sleep, Sleep Quality, Sleep Disturbances, and Daytime Dysfunction using 4 linear mixed effects models (intent-to-treat analyses) controlling for age, gender, and race.

Results: The overall effect of time was significant for all sleep measures, such that sleep improved over time (ps <0.02). From baseline to 5 yrs, sleep score improvements ranged from 21-28% (ps <0.02).

Conclusions: Participants in a virtual nutrition therapy intervention focused on nutritional ketosis reported long-term improvements in sleep out to 5 yrs concurrent with sustained metabolic health improvements. This provides additional evidence that this intervention benefits overall health. Additional research is needed to better understand what drove perceptions of sleep improvement.