By Colin Kenny, Editor – Diabetes Distilled
Sustained weight loss results in the long-term remission of diabetes in a third of patients, according to researchers involved in the Diabetes Remission Clinical Trial (DiRECT). In this ongoing study in obese patients with type 2 diabetes, 36% of participants given a low-calorie formula diet for the first 3 months and then a structured diet using normal food to support weight maintenance were still in remission at 2 years, compared to just 3% of the control group, who received best-practice care in accordance with guidelines. The original study demonstrates the importance of marked weight loss (>15 kg), which achieved a 46% remission of diabetes. This follow-up study shows a clear dose–response relationship between the amount of weight loss and remission of diabetes. About one in three obese people with type 2 diabetes, given the weight loss and maintenance advice, were able to control their blood sugar levels, reducing the need for medication.
DiRECT is an open-label, cluster-randomised controlled trial being performed in randomly-assigned primary care practices. Recruits to the study were aged 20–65 years with type 2 diabetes duration of <6 years, a BMI of 27–45 kg/m2 and were not receiving insulin. At the start of the study, medication for diabetes and hypertension was withdrawn and a low-calorie formula diet instigated (825–853 kcal/day) for 12–20 weeks, followed by stepped food reintroduction (2–8 weeks) and then structured weight loss maintenance support.
At 24 months, 53/149 (35.6%) of those commencing the intervention and 5/149 (3.4%) individuals in the control group were in remission. Weight loss of ≥15 kg was recorded in 11.4% (17/149) of the intervention group and 2.0% (3/149) of the control group. There was a clear dose–response relationship between the amount of weight lost and the remission of diabetes. Weight loss of ≥10 kg resulted in remission in two-thirds of participants. This programme showed sustained remissions at 24 months for over a third of people with type 2 diabetes.
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