Total diet replacement within an integrated intensive lifestyle intervention for remission of type 2 diabetes: lessons from DiRECT

Noronha, J. C., Thom, G. and Lean, M. E.J. (2022) Total diet replacement within an integrated intensive lifestyle intervention for remission of type 2 diabetes: lessons from DiRECT. Frontiers in Endocrinology, 13, 888557. (doi: 10.3389/fendo.2022.888557) (PMID:35721753) (PMCID:PMC9202990)

Abstract

The prognosis for people with type 2 diabetes (T2D) remains concerning, yet its seriousness is often underestimated. T2D is a manifestation, in susceptible individuals, of the disease-process of obesity, and at diagnosis, 10-year survival rates for T2D are around 50%. Here, we will examine: (a) the role of weight loss in T2D, (b) use of total diet replacements (TDRs) to induce weight loss, (c) the Diabetes Remission Clinical Trial (DiRECT) protocol and key results, (d) other dietary interventions related to T2D remission, (e) remission in real life, and (f) future directions. Remission of short-duration T2D will usually require 10-15% body weight loss, and results from the DiRECT trial demonstrated that this can be achieved within routine care in nearly half of all people undertaking a supported, TDR-led behavioural weight management programme. In light of these findings, which have since been replicated in the Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I) trial conducted in the Middle East and North Africa, it is now time to prioritize weight loss programmes for T2D remission from diagnosis, and with increasing acceptance and availability of digital healthcare, there is an opportunity to scale up delivery of remission programmes in a cost effective manner.

• Item Type: Articles
• Additional Information: Aspects of this work were supported by the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. This included journal publication costs, overheads costs, and author honoraria (JCN only).
• Keywords: Endocrinology, total diet replacement, obesity treatment, weight loss, diabetes, diabetes remission.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lean, Professor Michael and Thom, Dr George
• Authors: Noronha, J. C., Thom, G., and Lean, M. E.J.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Frontiers in Endocrinology
• Publisher: Frontiers Media
• ISSN: 1664-2392
• ISSN (Online): 1664-2392
• Copyright Holders: Copyright © 2022 Noronha, Thom and Lean
• First Published: First published in Frontiers in Endocrinology 13: 888557
• Publisher Policy: Reproduced under a Creative Commons License