Outcomes at a metabolic health clinic: A medical audit

Background: A low proportion of Americans are deemed metabolically healthy by the Centers for Disease Control and Prevention. There is a need for different approaches to addressing metabolic health in the United States, with therapeutic carbohydrate reduction being one potential intervention. Aim: To quantify the change across follow-up in outcomes (haemoglobin A1c [HbA1c], triglycerides [TGs], high-density lipoprotein cholesterol [HDL-c], high-sensitivity C-reactive protein [hsCRP] and Homeostatic Model Assessment of Insulin Resistance [HOMA-IR] scores) at a metabolic health clinic implementing a very low carbohydrate approach to eating. Setting: The study took place at the CHI Metabolic Health Clinic in Elkhorn, Nebraska. Methods: A cohort of 414 patients with 1234 observations was used in this study. Patient-level data included all available lab values recorded across a minimum of an 8-month follow-up. To account for variable patient follow-up time, frequency and the correlation of repeated observations by individual patients, separate linear mixed models with random intercepts were estimated for each metabolic outcome. Additional sub-analysis was conducted among patients with high baseline HbA1C (values of 5.7% or 39 mmol/mol or greater). Results: All five of the lab values tracked in this study had positive expected changes regarding their effect on health outcomes. The overall patient population experienced expected decreases in HbA1c, TGs, hsCRP and HOMA-IR scores while increasing HDL-c levels. Among patients with a high initial HbA1c, the positive changes of HbA1c, HDL-c and hsCRP were more pronounced. Discussion: All laboratory values tracked in this clinic moved in a positive direction regarding their effects on health outcomes. This is consistent with the previous evidence presented on implementation of therapeutic carbohydrate reduction in clinical practice. Conclusion: Clinics advocating for a therapeutic carbohydrate reduction play a valuable role in the management of metabolic dysfunction.