Predictors of type 2 diabetes in the Diabetes Remission Clinical Trial (DiRECT)

Thom, G. et al. (2021) Predictors of type 2 diabetes in the Diabetes Remission Clinical Trial (DiRECT). Diabetic Medicine, 38(8), e14395. (doi: 10.1111/dme.14395) (PMID:32870520)

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AIM:To identify predictors of type 2 diabetes remission in the intervention arm of DiRECT (Diabetes Remission Clinical Trial). METHODS:Participants were aged 20-65 years, with type 2 diabetes duration of <6 years and BMI 27-45 kg/m2 , and were not receiving insulin. Weight loss was initiated by total diet replacement (825-853 kcal/day, 3-5 months, shakes/soups), and weight loss maintenance support was provided for 2 years. Remissions [HbA1c <48 mmol/mol (<6.5%), without antidiabetes medications] in the intervention group (n = 149, mean age 53 years, BMI 35 kg/m2 ) were achieved by 68/149 participants (46%) at 12 months and by 53/149 participants (36%) at 24 months. Potential predictors were examined by logistic regression analyses, with adjustments for weight loss and effects independent of weight loss. RESULTS:Baseline predictors of remission at 12 and 24 months included being prescribed fewer antidiabetes medications, having lower triglyceride and gamma-glutamyl transferase levels, and reporting better quality of life with less anxiety/depression. Lower baseline HbA1c was a predictor at 12 months, and older age and male sex were predictors at 24 months. Being prescribed antidepressants predicted non-remission. Some, but not all effects were explained by weight loss. Weight loss was the strongest predictor of remission at 12 months (adjusted odds ratio per kg weight loss 1.24, 95% CI 1.14, 1.34; P < 0.0001) and 24 months (adjusted odds ratio 1.23, 95% CI 1.13, 1.35; P <0.0001). Weight loss in kilograms and percentage weight loss were equally good predictors. Early weight loss and higher programme attendance predicted more remissions. Baseline BMI, fasting insulin, fasting C-peptide and diabetes duration did not predict remission. CONCLUSIONS:Other than weight loss, most predictors were modest, and not sufficient to identify subgroups for which remission was not a worthwhile target.

Item Type:Articles
Glasgow Author(s) Enlighten ID:McCombie, Ms Louise and Messow, Dr Martina and Brosnahan, Miss Naomi and Lean, Professor Michael and Welsh, Dr Paul and Thom, Dr George and Sattar, Professor Naveed and Leslie, Dr Wilma
Authors: Thom, G., Messow, C.-M., Leslie, W.S., Barnes, A.C., Brosnahan, N., McCombie, L., Al-Mrabeh, A., Zhyzhneuskaya, S., Welsh, P., Sattar, N., Taylor, R., and Lean, M.E.J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Diabetic Medicine
ISSN (Online):1464-5491
Published Online:01 September 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Diabetic Medicine 38(8): e14395
Publisher Policy:Reproduced under a Creative Commons licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
190677Reversal of T2DM to normal glucose tolerance using non-surgical weight management with low-energy-liquid-diet and long-term maintenance, within routine NHS care.Michael LeanDiabetes UK (DIABETUK)13/0004691Med - Human Nutrition