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Background: Low-carbohydrate diets decrease hemoglobin A1c among patients with type 2 diabetes mellitus. However, evidence on effects of low-carbohydrate diets on hemoglobin A1c among individuals with prediabetes is limited. Methods: We conducted a randomized parallel-group trial of 150 adults aged 40-70 years with untreated hemoglobin A1c from 6.0-6.9%. Participants were assigned to a healthy low-carbohydrate diet (target Results: Mean age was 59 years; 72% were female and 59% were Black. 95% completed the study. Participants in the low-carbohydrate arm had significantly greater 6-month decrease in hemoglobin A1c (net difference, -0.23% [95% CI, -0.32 to -0.14%]) , fasting plasma glucose (net difference, -10.3 mg/dL [95% CI, -15.7 to -4.9 mg/dL]) , and body weight (net difference, -5.9 kg [95% CI, -7.2 to -4.7 kg]) compared with usual diet arm. At 6 months, 53% in the low-carbohydrate arm and 32% in the usual diet arm had hemoglobin A1c Conclusion: A healthy low-carbohydrate diet led to improvements in glycemic and other cardiometabolic outcomes in adults with elevated hemoglobin A1c and could be recommended for prevention of type 2 diabetes mellitus. Disclosure K.S.Dorans: None. M.J.O'brien: None. G.I.Uwaifo: None. J.He: None. L.A.Bazzano: None. L.Qi: None. H.He: None. J.Chen: None. L.J.Appel: n/a. F.Hu: None. J.Samet: None. K.T.Mills: None. Funding National Institute of General Medical Sciences (1P20GM109036-01A1) . The California Walnut Commission (Folsom, CA) supported the study by providing walnuts. Shakes and bars were donated by The Simply Good Foods Company (Denver, CO) . Sugar replacement samples were provided by Swerve LLC (New Orleans, LA) .

Background: In the US Diabetes Prevention Program (DPP) trial, a lifestyle intervention program focused on changes in diet and physical activity led to a 58% reduction in risk of developing type 2 diabetes. A variety of modifications to the DPP have been tested in clinical trials. We sought to compare the effects of different strategies for implementation of the US DPP on weight and other cardiometabolic outcomes. Methods: We conducted systematic searches of MEDLINE and Embase from January 2002 to August 2020. We included randomized controlled trials of adults that tested the effect of an intervention based on the US DPP on change in weight. Studies of at least 6 months duration were included. Two investigators independently extracted data. DPP implementation strategies were classified into eight different categories. Results: A total of 30 comparisons from 28 articles with 8,284 participants were included. Different strategies for implementing the DPP led to significant decreases in change in weight in the DPP compared with control arms during follow-up (Table). These strategies included intervention delivery through group sessions or combination of group and individual sessions. Additionally, interventions delivered by telehealth or by a combination of in-person and telehealth were effective. Conclusion: A number of different strategies for implementing the DPP lead to clinically meaningful decreases in weight. Disclosure K. S. Dorans: None. K. T. Mills: None. Y. Feng: None. A. A. Sethi: None. X. Li: None. J. He: None. Funding National Institute of General Medical Sciences (1P20GM109036-01A1)

Background: Women with prior gestational diabetes (GDM) are at elevated risk of type 2 diabetes and cardiovascular disease. We sought to compare cardiometabolic risk factors among parous U.S. women ages 20 to 44 by history of GDM. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) from 2007-2016. We included 3562 parous women. We compared anthropometric measures, glycemic markers, blood pressure and lipids by self-reported history of GDM, both with and without adjusting for demographic and behavioral factors and waist circumference. Analyses took NHANES multi-stage survey design into account. Results: Women without history of GDM were younger and, in crude analyses, had more favorable cardiometabolic risk factor profile than women with history of GDM (Table). Similar patterns were observed after adjusting for age, race/ethnicity, education and smoking. After also adjusting for waist circumference, only hemoglobin A1c, fasting glucose, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were significantly higher among women with history of GDM compared to women without GDM. Conclusions: Among parous U.S. women ages 20 to 44, those with a history of GDM had less favorable cardiometabolic risk factor profiles than did women without GDM, though results were attenuated after adjusting for markers of demographics, behavior, and central obesity. Disclosure K.S. Dorans: None. L.A. Bazzano: None. J. He: None. Funding Tulane Center of Biomedical Research (P20GM109036)