Brief formula low‐energy‐diet for relapse management during weight loss maintenance in the Diabetes Remission Clinical Trial (DiRECT)

Brosnahan, N. , Leslie, W., McCombie, L., Barnes, A., Thom, G. , McConnachie, A. , Messow, C. M. , Sattar, N. , Taylor, R. and Lean, M. E.J. (2021) Brief formula low‐energy‐diet for relapse management during weight loss maintenance in the Diabetes Remission Clinical Trial (DiRECT). Journal of Human Nutrition and Dietetics, 34(3), pp. 472-479. (doi: 10.1111/jhn.12839) (PMID:33406285)

Abstract

Background Weight loss maintenance (WLM) is critical for sustaining type 2 diabetes (T2D) remission, but poorly evidenced. We evaluated brief return to formula low‐energy‐diet (LED) as relapse treatments (RTs) during the WLM phase of the Diabetes Remission Clinical Trial (DiRECT). Methods This post‐hoc evaluation included all participants commencing the WLM phase of DiRECT. The protocol offered RT when regain of >2 kg occurred. Results In total, 123/149 (83%) DiRECT intervention participants commenced the WLM phase after 26 (17%) had withdrawn prior to the WLM phase. Most participants [99/123 (80%)] regained >2 kg during the WLM phase, among whom 60/99 (61%) were recorded as using RT and 39/99 (39%) not using any RT. At baseline, RT users had a higher mean (SD) body mass index [35.8 (4.9) kg m−2 vs. 33.8 (3.9) kg m−2, p = 0.0231] and had greater social deprivation (P = 0.0003) than non‐users, although otherwise the groups were similar. Weight loss ≥ 2k g was achieved in 30/93 (32%) of RT attempts. At 2 years, those regaining >2 kg and using RT (n = 60) had mean (SD) weight losses of 7.4 (6.1) kg, with 25 (42%) remissions and 7 (12%) programme withdrawals. Those regaining >2 kg but not using RT (n = 39) had weight losses of 8.8 (6.0) kg, with 21 (54%) remissions and 4 (10%) programme withdrawals (all not significant). Twelve participants were never recorded as having regained >2 kg or using RTs and, at 2 years, their weight losses were 12.9 (9.2) kg, with 4 (33%) remissions and 8 (67%) programme withdrawals. Conclusions Most people with T2D experience weight regain >2 kg during the 2 years after substantial weight loss with a LED. Only one‐third of RTs corrected their 2‐kg regain, resulting in similar weight losses, remissions and programme withdrawals at 2 years compared to those not using RTs; however, both groups had weight losses below those not recorded as regaining >2 kg during WLM.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McConnachie, Professor Alex and Brosnahan, Dr Naomi and Thom, Dr George and Messow, Dr Martina and McCombie, Ms Louise and Lean, Professor Michael and Sattar, Professor Naveed and Leslie, Dr Wilma
• Authors: Brosnahan, N., Leslie, W., McCombie, L., Barnes, A., Thom, G., McConnachie, A., Messow, C. M., Sattar, N., Taylor, R., and Lean, M. E.J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Human Nutrition and Dietetics
• Publisher: Wiley
• ISSN: 0952-3871
• ISSN (Online): 1365-277X
• Published Online: 06 January 2021
• Copyright Holders: Copyright © 2021 The British Dietetic Association Ltd.
• First Published: First published in Journal of Human Nutrition and Dietetics 34(3): 472-479
• Publisher Policy: Reproduced in accordance with the publisher copyright policy

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
190677		Reversal 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 Lean	Diabetes UK (DIABETUK)	13/0004691	Med - Human Nutrition