Weight loss helps achieve remission from type 2 diabetes for five years: New Data from DIRECT trial

UK: New findings have suggested that weight loss can help to achieve remission from type 2 diabetes for at least five years.

New data revealed that nearly a quarter of participants who were in remission from type 2 diabetes two years after initiating a low-calorie diet in the DiRECT trial remained in remission at five years.

These individuals no longer require diabetes medications to manage their blood sugar levels. Those still in remission had an average weight loss of 8.9kg at five years.

The findings of the research, led by Roy Taylor at Newcastle University and Professor Mike Lean at the University of Glasgow, will be presented at the Diabetes UK Professional Conference 2023 in Liverpool on 26 April. 

The proportion of participants in the extension of the landmark DiRECT (Diabetes UK-funded Diabetes Remission Clinical Trial) remission after five years was revealed to be more than three times that of the DiRECT control group, who did not participate in the original low-calorie diet programme or receive continued low-intensity weight management support in the extension trial.

"The five-year follow-up of the DiRECT trial shows that the rapid weight loss programme brings about considerable weight loss at five years with low-intensity support," Professor Roy Taylor at Newcastle University said. "The most important question now is how the follow-up programme can be even more successful at an affordable cost."

The researchers found major overall benefits to people originally assigned to the weight loss group. They had around half the serious health issues causing hospital admission and reported feeling 'much better' due to weight loss. The study has been life-changing for those who remain free of diabetes. 

The original DiRECT trial of a weight management programme for patients diagnosed with type 2 diabetes within the last six years involved a low-calorie formula diet, followed by support to reintroduce healthy food and gradually maintain weight loss. 

The trial conducted at Newcastle University was the first to reveal that type 2 diabetes remission is possible through a dietary intervention in primary care, with almost half (46%) of people in remission at one year and 36% at two years.

In the study's extension, to understand the programme's longer-term benefits, 95 intervention group participants of the original two-year DiRECT study (48 of whom were in remission at the start of the extension) continued to receive support to help maintain weight loss over the next three years. They received nurse or dietitian appointments at their GP surgery every three months to review their blood sugar levels, weight, and blood pressure and were offered advice and support to maintain their weight loss.

Individuals who regained over 2 kg during years 3-5 were offered an additional package of support, available once each year, consisting of the low-calorie ‘soups and shakes’ diet for four weeks, followed by support while reintroducing normal meals.

During the three-year extension, 82 participants from the original DiRECT control group – who originally received the best type 2 diabetes care according to guidelines – were advised to lose weight. Control participants did not receive the three-monthly appointments or additional ‘soups and shakes’ packages during the extension period. 

The diRECT study played an important role in transforming the lives of patients with type 2 diabetes by showing that the condition can be remitted through weight loss. The new findings from DiRECT confirm that for some people, it is possible to stay in remission for at least five years.

The authors suggest that for people unable to go into remission, weight loss can still help them achieve major health benefits, including improved blood sugar levels and lower risk of serious complications such as stroke and heart attack.