Cardiovascular Outcomes Among Adults with Type 2 Diabetes or Obesity Receiving Carbohydrate-Reduced Nutrition via Telemedicine: A Retrospective Claims-Based Cohort Study.

INTRODUCTION Cardiovascular (CV) risk factors improve with carbohydrate-reduced nutrition, but the impact on CV outcomes is unknown. We assessed the incidence of CV outcomes associated with a carbohydrate-reduced telemedicine intervention in a retrospective claims-based cohort study.

Methods

Adults with type 2 diabetes or obesity receiving individualized nutritional therapy (INT) between January 1, 2016 and June 1, 2025, were compared with propensity score-matched controls. Primary outcomes included (1) 3-point major adverse CV events (MACE), defined as nonfatal myocardial infarction, nonfatal stroke, or death from any cause (MACE-3); (2) 6-point MACE, adding percutaneous coronary intervention, hospitalization for heart failure or unstable angina (MACE-6); (3) all new-onset CV disease (CVD) events; and (4) new-onset hypertension.

Results

In 4877 participants in each cohort (mean age, 51 [SD 9.5] years; 2939 [60.3%] female), INT was associated with lower risk of all primary outcomes. Incidence per 1000 person-years was 4.1 vs. 9.3 for MACE-3, 5.7 vs. 10.8 for MACE-6, 27.7 vs. 36.9 for all new-onset CVD, and 41.8 vs. 49.3 for new-onset hypertension. Hazard ratios were 0.44 (95% CI, 0.29-0.65; P < 0.001) for MACE-3, 0.52 (95% CI, 0.37-0.73; P < 0.001) for MACE-6, 0.70 (95% CI, 0.59-0.82; P < 0.001) for all CVD, and 0.81 (95% CI, 0.70-0.93; P < 0.001) for new-onset hypertension.

Conclusions

Individualized telemedicine nutrition therapy was associated with lower CV event incidence compared to controls, suggesting the intervention may confer cardioprotection.