Following the positive 2-year results of DiRECT, this symposium shared the first-hand experiences of a dietician, a general practitioner, and a person with diabetes who participated in the DiRECT study.

Amar Puttanna highlights the key clinical messages that have come out of the DiRECT trial (0:59).

Roy Taylor explains why the DiRECT intervention may benefit a surprisingly wide variety of people, and how the trial’s findings could trigger a major shift in thinking about how to tackle type 2 diabetes (6:45).

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 trial, the investigators report.

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

Ghrelin is the only appetite-related hormone that predicted weight regain among the participants of the DiRECT trial, say the researchers.

Following a very-low-calorie total diet replacement plan can lead to type 2 diabetes remission in South Asian individuals, shows the STANDby trial.

Levels of the inflammatory marker C-reactive protein decrease in people with or without type 2 diabetes taking weekly semaglutide 2.4 mg, shows analysis of three STEP trials.

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 (25:34).

A randomised trial shows that use of a prebiotic fibre-enriched nutritional formula results in improved life quality and, potentially, better glycaemic control in people with type 2 diabetes.

By contrast, in the DiRECT trial , which definitively showed that type 2 diabetes can be reversed with diet-induced weight loss, the average BMI was approximately 35 kg/m 2 .

The very-low-calorie diet intervention used in the DiRECT trial is feasible and associated with type 2 diabetes remission in residents of Barbados, researchers report.

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.

John Wilding discusses the implications of the 2-year outcomes of the DiRECT trial, and the questions that remain unanswered (4:17).

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.

Hamilton-Shield stresses that diet must be the mainstay of pediatric type 2 diabetes management, pointing to the success of the DiRECT trial , which showed that targeting 15 kg weight loss in adults using a very-low-calorie meal replacement plan led to type 2 diabetes remission for nearly half of the participants.

With clinical data from head-to-head comparisons of multiple antidiabetic agents not currently available and no such clinical trials planned, Al-Aly and co-investigators decided to conduct a pragmatic trial.

Many participants of DiRECT found reintroduction of food and subsequent weight-loss maintenance to be more challenging than the 800 calorie total meal replacement phase, the investigators report.

All DiRECT participants had BMIs of 27–45 kg/m 2 , but those with type 2 diabetes had average liver fat of around 15%, compared with around 5% in those without.