Delivering the Diabetes Remission Clinical Trial (DiRECT) in primary care: experiences of healthcare professionals

Rehackova, L., Taylor, R., Lean, M. , Barnes, A., McCombie, L., Thom, G. , Brosnahan, N. , Leslie, W. S. and Sniehotta, F. F. (2022) Delivering the Diabetes Remission Clinical Trial (DiRECT) in primary care: experiences of healthcare professionals. Diabetic Medicine, 39(3), e14752. (doi: 10.1111/dme.14752) (PMID:34837259)

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Objective: The Diabetes Remission Clinical Trial (DiRECT) used a formula total diet replacement programme followed by structured weight loss maintenance to induce and sustain weight loss and remission of type 2 diabetes (T2D) in 36% of participants after 2 years. Nurses and dietitians delivering DiRECT in 22 primary care practices in Tyneside and Scotland provided behavioural support to participants. Participant experiences with DiRECT highlighted the key role of support by healthcare professionals (HCPs). We evaluated HCPs’ experiences with DiRECT. Research design and methods: Healthcare professionals delivering DiRECT were interviewed at 12 months, while general practices (GPs) were sent an implementation questionnaire. The interviews were analysed thematically. The questionnaires were analysed using frequencies and a narrative synthesis. Results: Healthcare professionals representing 11 of 22 intervention practices were interviewed and 10 of 22 GPs completed questionnaires. HCPs’ initial concerns over perceived potential negative intervention effects, particularly withdrawing anti-diabetes and anti-hypertensive medications, were barriers to engagement. Trust of HCPs towards the research team and perceived credibility of the study facilitated engagement and adoption. Ongoing support by research dietitians was key to the management of participants. Involvement in DiRECT inspired more focus on behaviour modification in the treatment of other people living with T2D in routine practice. Conclusions: Diabetes Remission Clinical Trial was considered highly appropriate for the management of T2D in primary care when supported by trained dietitians. Addressing limitations, including varying training needs of HCPs may improve intervention scale-up and tailoring to clinical contexts.

Item Type:Articles
Glasgow Author(s) Enlighten ID:McCombie, Ms Louise and Brosnahan, Dr Naomi and Lean, Professor Michael and Thom, Dr George and Leslie, Dr Wilma
Authors: Rehackova, L., Taylor, R., Lean, M., Barnes, A., McCombie, L., Thom, G., Brosnahan, N., Leslie, W. S., and Sniehotta, F. F.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Diabetic Medicine
ISSN (Online):1464-5491
Published Online:27 November 2021
Copyright Holders:Copyright © 2021 Diabetes UK
First Published:First published in Diabetic Medicine 39(3): e14752
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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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