DiRECT: Type 2 diabetes remission through weight management
Primary findings, 2-year outcomes and translating this landmark trial into practice
The primary findings
The ground-breaking Diabetes Remission Clinical Trial (DiRECT) showed for the first time that substantial weight loss achieved with diet alone in a primary care setting could reverse type 2 diabetes.
Nearly half of the patients helped to follow a very-low-calorie diet for at least 3 months achieved and maintained remission of type 2 diabetes over the 12 months of the DiRECT intervention, the investigators report.
The 2-year outcomes
The DiRECT investigators followed up the study participants to assess how many remained in remission.
Just over a third of people who undertook a period on a very-low-calorie diet in the DiRECT trial to tackle type 2 diabetes are in remission 24 months later, the investigators have reported.
DiRECT trial dietitian Alison Barnes discusses the challenges and triumphs of using a very-low-calorie, total-meal-replacement diet to help people with type 2 diabetes achieve weight loss and maintenance.
The strongest predictor of type 2 diabetes remission is weight loss, with other variables only modestly associated with outcome and insufficient to identify people unsuitable for attempting this goal, shows a post-hoc analysis of DiRECT data.
People who achieved sustained remission of type 2 diabetes via substantial weight loss in the DiRECT trial regained normal maximal beta-cell capacity, the investigators report.
Type 2 diabetes remission can be achieved within 1 year at a cost below the average annual cost of diabetes management, even when including complications, shows an economic evaluation of the DiRECT/Counterweight-Plus weight management program.
Researchers from the DiRECT trial have reported large positive effects on liver fat and insulin secretion among people who achieved type 2 diabetes remission in response to a very-low-calorie diet.
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