Five-Year Low-Carb Remote Care Kept Weight Off in Prediabetes

TL;DR: A digitally supported carbohydrate-reduced nutrition program was linked to 5.8 kg mean weight loss at five years, with 22% of the starting group at normoglycemia and 13% at type 2 diabetes, according to Frontiers in Nutrition.

Five-year follow-up of a continuous remote care intervention for prediabetes reported durable weight reduction alongside a low rate of progression to type 2 diabetes. The report, published in Frontiers in Nutrition on 19 June 2026, tracked adults first enrolled at ages 21–65 years with prediabetes. Of 96 participants in the original two-year trial, 58 agreed to a three-year extension and 45 completed five-year follow-up, representing 47% of the original cohort.

The analysis used generalized estimating equations and linear mixed-effects models as part of an extension cohort analysis. Outcomes over five years included glycemic status, weight, insulin resistance, lipids, inflammatory markers, and liver and kidney function. The underlying trial is registered as ClinicalTrials.gov NCT02519309. The extension was described as a three-year prospective, single-arm longitudinal study building on the previously reported two-year trial.

Why lasting prevention is difficult

Sustained prevention of type 2 diabetes remains a major public health challenge because benefits from traditional lifestyle and earlier pharmacologic interventions have often been difficult to maintain. Globally, more than 460 million people have prediabetes, with prevalence projected to increase substantially in coming decades. In the United States, more than one-third of adults — approximately 98 million people — have prediabetes.

Without intervention, up to 70% will eventually progress to type 2 diabetes. Even before progression, prediabetes is associated with elevated risk for cardiovascular disease, chronic kidney disease, and all-cause mortality. The authors framed durable maintenance of metabolic health, not only prevention of onset, as the central need.

Traditional programs achieved early success but rarely sustained it. The Diabetes Prevention Program reduced diabetes incidence by 58% over three years through modest weight loss and increased physical activity. In the Diabetes Prevention Program Outcomes Study, prevention effects diminished over time in the context of substantial weight regain, with more than half of participants ultimately developing diabetes.

That pattern was described as consistent with other lifestyle and dietary interventions, including low-calorie and low-fat approaches. Even pharmacologic approaches that produce substantial metabolic improvements, such as GLP-1 receptor agonists, show a regression of benefits upon discontinuation. The American Diabetes Association emphasizes durable lifestyle modification and individualized nutrition therapy for diabetes prevention, noting that low-carbohydrate eating patterns can be an effective option when adherence is maintained over time.

How the remote nutrition program worked

The study evaluated a continuous remote care intervention, abbreviated CCI, delivering individualized carbohydrate-reduced nutrition therapy in adults with prediabetes. Authors were affiliated with Virta Health in Denver, CO, United States; Genesis Research in Hoboken, NJ, United States; the Department of Human Sciences at The Ohio State University in Columbus, OH, United States; the School of Medicine at University of California, Davis, in Davis, CA, United States; and Abbott, Lingo Germany GmbH, in Wiesbaden, Germany.

Lead authors listed were Alison R. Zoller, Shaminie J. Athinarayanan, Michelle R. Van Tieghem, Rebecca N. Adams, Caroline G. P. Roberts, Jeff S. Volek, Stephen D. Phinney, and Amy L. McKenzie. The paper appeared in Frontiers in Nutrition, Section Clinical Nutrition, as an original research article. Its stated aim was to report five-year outcomes of continuous remote care with individualized carbohydrate-reduced nutrition therapy.

Participants were adults 21–65 years with prediabetes enrolled in the original trial. The extension cohort included 58 consenting participants followed for three additional years, for five years total. Assessment covered glycemic status alongside weight, insulin resistance, lipid measures, inflammatory markers, and hepatic and renal function. Change over time was modeled longitudinally rather than by comparison with a parallel control group, consistent with the single-arm extension design.

Glycemia after five years

At five years, 22% achieved normoglycemia, with P < 0.001, and 13% progressed to type 2 diabetes, with P < 0.01. Those percentages were calculated from the original cohort base in the reported extension analysis. Forty-five participants completed follow-up at five years.

Cumulative incidence, defined as achievement at any time point, was 55.6% for regression to normoglycemia and 12.2% for progression to type 2 diabetes over five years. The authors concluded that participation was associated with maintenance of glycemic status over five years among adults with prediabetes. They also noted that mean glycemic markers were comparable to baseline at five years.

The interpretation emphasized distribution of individual outcomes rather than average glucose alone. A substantial proportion achieved normoglycemia at some point, while relatively few progressed to type 2 diabetes during the period. The paper described this pattern as suggesting potential for long-term diabetes prevention with a digitally supported, nutrition-focused intervention.

Understanding glycemic categories helps place those shifts in context. According to Harvard Health, an optimal fasting blood glucose level is usually 70 to 99 milligrams per deciliter. Fasting blood glucose of 100 to 125 milligrams per deciliter indicates prediabetes, while 126 milligrams per deciliter or higher indicates diabetes.

With prediabetes and type 2 diabetes, high blood glucose occurs when the body is unable to use insulin efficiently. Over time, the body becomes unable to produce enough insulin. Insulin is the hormone that helps move blood sugar from the bloodstream into cells for energy. Type 2 diabetes accounts for 90% to 95% of diabetes cases in the United States.

Weight change held through year five

Mean body weight was reduced by 5.8 kg, or 5.3%, at five years, with P < 0.001. Among participants, 47% achieved at least 5% weight loss, 29% achieved at least 10% weight loss, and 13% achieved at least 15% weight loss. The authors described the result as significant weight reduction maintained over five years.

That durability contrasts with the regain pattern highlighted from prior lifestyle follow-up. In the Diabetes Prevention Program Outcomes Study context cited in the paper, prevention effects diminished alongside substantial weight regain. The present cohort, by contrast, remained below baseline weight on average at the five-year point.

Weight change matters for glucose control because excess weight contributes to inefficient insulin use. According to Harvard Health, a healthy eating pattern and attention to portion size can help reduce excess weight. That reduction allows the body to use insulin more efficiently, making it easier for cells to take up glucose and bringing down blood glucose levels.

The same source notes that losing around 7% of body weight may be enough to keep diabetes at bay. For a 160-pound person, that corresponds to a loss of around 11 pounds. Diet changes can still matter even when weight loss is small. Harvard Health reports patients who shed only 2 to 3 pounds despite following a diabetes-friendly diet but still improved blood sugar and blood cholesterol.

Heart-related and inflammatory markers

Fasting insulin, HOMA-IR, triglycerides, HDL-C, LDL-C, non-HDL-C, and hsCRP were maintained at or below baseline levels at five years. Those differences were not statistically significant after adjustment, despite unadjusted P-values at or below 0.05. The conclusion described the pattern as maintenance of insulin resistance and cardiometabolic risk markers.

HOMA-IR is the reported measure of insulin resistance in the analysis. Triglycerides, HDL-C, LDL-C, and non-HDL-C were the reported lipid measures. High-sensitivity C-reactive protein, abbreviated hsCRP, was the reported inflammatory marker. All were assessed alongside glycemic status and weight through the five-year period.

Liver and kidney function was stable over the follow-up period. Hepatic and renal markers were included among the prespecified long-term outcomes. No progression signal in those safety domains was reported in the abstract results.

For consumers, broader eating guidance remains relevant alongside any specific program. According to Harvard Health, many different foods can fit a prediabetes eating pattern, including fruits and vegetables, beans and legumes, lean proteins, whole grains, and healthy fats. Prediabetes diets generally are low in sugary foods, refined carbohydrates, fast foods, fried foods, and alcohol, while no foods are described as categorically off-limits.

What foods fit a prediabetes pattern

Specific options listed by Harvard Health include non-starchy vegetables such as asparagus, beets, broccoli, Brussels sprouts, carrots, cauliflower, cucumbers, eggplant, leafy greens, mushrooms, peppers, summer squash, tomatoes, and zucchini. Lean protein options include beans, eggs, fish and shellfish, lean poultry, lean red meat such as sirloin or flank steak, lentils, reduced-fat cheese, and soy foods such as tofu and tempeh.

Fresh fruit options include apples, apricots, bananas, berries, melon, oranges, peaches, and pears. Whole grains and starchy vegetables include whole-wheat bread, whole-wheat pasta, brown rice, oatmeal, quinoa, sweet potatoes, skin-on white potatoes, winter squash, peas, and corn. Low-fat dairy includes low-fat milk, plain Greek yogurt, and cottage cheese.

Healthy fats include olive oil and olives, avocado, nuts, and seeds. Water and unsweetened drinks are the listed beverage options. The dietitian guidance emphasizes overall eating pattern rather than single foods or super foods. Focusing on the average of what is eaten also allows for small treats and occasionally dining out.

Carbohydrate type affects blood sugar because the body breaks carbohydrates down into glucose. That glucose enters the bloodstream, raising blood glucose, and the pancreas releases insulin to move glucose into cells for energy. Choosing complex or minimally refined carbohydrates can make prediabetes management easier.

Limitations readers should weigh

The extension was single-arm, without a concurrent comparison group over five years. Only 58 of 96 original participants consented to the extension, and 45 completed five-year follow-up. Findings therefore reflect participants who remained in remote care and returned for assessment.

Lipid, insulin-resistance, and inflammation differences met the unadjusted threshold but did not remain statistically significant after adjustment. Mean glycemic markers were comparable to baseline at five years, even as categorical outcomes showed 22% at normoglycemia and 13% at type 2 diabetes. The authors presented association, not proof of causation, using language of participation being associated with outcomes.

Lifestyle changes such as eating a healthy diet and being more active are first-line treatments for prediabetes, according to Harvard Health. Both can bring blood sugar levels closer to normal, which can slow or stop progression to diabetes. Unmanaged prediabetes can turn into type 2 diabetes, which can lead to long-term problems such as heart disease, nerve damage, and kidney disease.