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05-04-2023 | Diet | News

DiRECT extension shows potential for persistent type 2 diabetes remission

Author: Eleanor McDermid


medwireNews: The 5-year DiRECT results show sustained type 2 diabetes remission for 13% of the intervention group.

In the DiRECT trial, which is co-led by Roy Taylor (Newcastle University, UK) and Mike Lean (University of Glasgow, UK), people with type 2 diabetes of less than 6 years’ duration were randomly assigned to target 15 kg of weight loss by means of a very-low-calorie total meal replacement diet for 3–5 months or to receive usual weight management support.

As previously reported, the proportion of the intervention group who achieved remission was 46% (of 149 people) after 12 months and 36% after 24 months.

This has now fallen further, to 13% after 5 years, whereas 5% of the 149 people in the control group were in remission at this point.

In parallel with the falling remission rate, the intervention group regained weight until the change from baseline was very similar to that of the control group. Nevertheless, both groups remained significantly below their baseline bodyweight, by an average of 6.1 and 4.6 kg, respectively.

During the extension phase, the intervention group continued to receive low-intensity weight management support, in the form of an appointment with a dietitian or nurse every 3 months and the option to use a once-daily meal replacement product and to revert to a 4-week period of total meal replacement if required.

By the end of these 5 years, 85 people from the intervention group and 82 from the control group had follow-up data.

Remission was defined as having glycated hemoglobin (HbA1c) below 48 mmol/mol (6.5%) without use of diabetes medications. In total, 14% and 13% of the intervention and control groups, respectively, had achieved the HbA1c target at year 5, and 40% versus 13% were not using diabetes medications. In addition, 47% versus 35% were not using antihypertensives.

The researchers reported that the intervention group did better than the controls on several measures over the course of the 5-year trial. They spent a significantly greater amount of the 5 years with bodyweight more than 10 kg below baseline (27 vs 8%), with HbA1c below 48 mmol/mol (29 vs 15%), off all diabetes medications (51 vs 16%), and in remission (27 vs 4%).

The intervention group also had a significantly lower rate of serious adverse events per 100 person–years, at 5.1 versus 10.3 in the control group.

Based on these findings, the investigators concluded that intensive weight management “deserves greater priority” to facilitate type 2 diabetes remission, but stressed the need for further research into maintaining weight loss.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2023 Springer Healthcare Ltd, part of the Springer Nature Group

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