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Latest results from the DiRECT study

by FayeRiley
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Updated February 26, 2024: This article has been updated with new findings from the groundbreaking DiRECT study published in The Lancet.

A three-year extension of our groundbreaking DIRECT study reveals that it is possible to keep type 2 diabetes in remission for at least five years in some people. But the findings highlight that maintaining weight loss and staying in remission can be difficult.

Thirteen percent of people who took a weight management program and continued to receive support through an extension study had their type 2 diabetes in remission after five years, according to new findings.

Remission means that blood sugar levels return to a non-diabetic range over time without the need for antidiabetic drugs.

The findings also show that the program may have lasting health benefits, but only during an extended period (3-5 years after receiving the “soup and shake” weight management program). Gaining weight back or falling out of remission was common.

The DiRECT expansion was led by Professor Roy Taylor and Professor Mike Leen (both pictured) and was published in The Lancet.

Remission in the long term

The first DiRECT trial started in 2014 and ran for two years. Previous results have shown that almost half (46%) of type 2 diabetics who undergo a weight management program are in remission after one year, and 36% after two years. .

We funded the DiRECT Extension Study to better understand the long-term benefits of the program.

In the extension study, researchers followed participants in the original DiRECT intervention group who received a weight management program and participants in the original control group who did not receive a program but received weight management advice for an additional three years. investigated. Year.

Some participants in the first intervention group chose to continue receiving support and advice from their GP to maintain their weight loss over the next three years. Those who regained more than 2 kg of weight in 3 years were offered an additional support package. This consisted of a 4 week low calorie ‘soup and shake’ diet and support to reintroduce normal eating.

Latest remission results

At year 5, remission data were available for 93 patients from the original control group and 118 from the original intervention group (including 85 patients who continued to receive support from their primary care physician in years 3 to 5).

Over the entire five-year study period, people in the intervention group spent an average of 27% of their time in remission. This compares with 4% of the control group who did not receive a weight management program. The intervention group also weighed less than baseline, took no hypoglycemic drugs, and spent more time with blood sugar levels in the non-diabetic range than the control group.

Remission and weight loss benefits

While it is encouraging that the latest research results show that some people can remain in remission for five years, they also found that this is not possible for most people. Many people who regain the weight they lost go back into remission. But no matter how long you’ve been in remission, it’s important to remember that staying in remission can have lasting health benefits.

Another landmark remission study, called Look AHEAD, recently found that those who went into remission at any point during the 12-year study period were less likely to have heart and kidney complications than those who did not go into remission. It was found that the risk of

Maintaining remission can be difficult. There is always a chance that your blood sugar levels and weight will rise again, and you can go back and forth in remission.

But even if you only stay in remission for a short period of time, or even if you don’t reach full remission, the combination of lower blood sugar levels and weight loss from attempting remission can have significant health benefits. There is a possibility. Gaining weight back and coming out of remission doesn’t mean you’ve failed, and with effort you can improve your health and potentially return to remission again in the future.

People who are overweight or obese and trying to manage their weight are fighting against their own biology and food environment. Over time, this complex interaction can make it difficult to avoid gaining weight back. That’s why it’s so important to get the right support to maintain weight loss and maintain remission.

Get more information about remission and its benefits.

Kieran Ball was diagnosed with type 2 diabetes in 2013 and started DiRECT the following year. During the first year of his study, Kieran lost 22kg of his weight and put his type 2 diabetes into remission. He underwent DiRECT expansion and is currently in remission. Mr Kieran said:

“DiRECT was 100% life-changing. The few months I was on a low-calorie diet were tough, but I would definitely do it again. DiRECT was an opportunity to reboot my way of life. I’m so grateful that it gave me a chance. It’s amazing how what I went through all those years ago still helps me. I’m still in remission and my diabetes I haven’t even taken any medication. I can’t believe it’s been so long.”

Read Kieran’s story.

What’s next?

Although scientists have made great strides in building knowledge about dietary approaches to remission over the past decade, this is still a fairly new idea. There is still much to learn so that we can give more people the best chance of losing weight, maintaining weight loss, and staying in remission.

We are proud that DiRECT’s discoveries are already impacting diabetes treatment and influencing the NHS Pathways to Type 2 Diabetes Remission programme. As this is rolled out across England, we will have more valuable real-world data on weight loss, remission and its benefits for people with newly diagnosed type 2 diabetes.

Further research is also needed to understand how best to support people with type 2 diabetes to maintain weight loss and remission over the long term. Also, the DiRECT-style approach is not suitable for all type 2 diabetics, so new or better routes to remission need to be found.

That’s why we invest in important research like the NewDAWN study. Our researchers are developing a new national NHS support service that will provide a range of weight loss diets to people who are overweight or obese or newly diagnosed with type 2 diabetes. I hope this helps everyone who benefits find the approach that works for them and the opportunity to be free of type 2 diabetes.

We are now calling on scientists to come up with research ideas and apply for funding that will improve the understanding and support for people with Type 2 as they aim to enter or maintain remission.

Dr Elizabeth Robertson, our research director, said:

“Diabetes UK is proud to have funded over a decade of research that has broken new ground and put remission on the map for people with type 2 diabetes.

“When type 2 diabetes goes into remission, it reduces the burden of 24/7 diabetes management and transforms health and well-being. But getting into remission is difficult, and staying in remission is even harder. That’s why we’re launching a new remission information and support hub and funding research to understand how we can help more people reach remission and stay in remission for longer. We continue to provide it.”

Professor Mike Lean from the University of Glasgow said:

“DiRECT has led to a global paradigm shift in the understanding and treatment of type 2 diabetes. The disease is not necessarily permanent, and these 5-year results demonstrate the importance of weight loss to achieve periods of remission. The study suggests that dieting for diabetes can increase freedom from some diabetes complications and reduce the number of people hospitalized with medical problems.

“We must now call for more effective, long-term funding for research to improve these outcomes, particularly to prevent weight gain.”

Professor Roy Taylor from Newcastle University said:

“This five-year study shows that long-term remission of type 2 diabetes is possible if sufficient weight loss is achieved and maintained.

“Regardless of whether diabetes remission was achieved, those assigned to the weight loss group had less than half the serious health problems that the conventional treatment group experienced. These are dramatic results, and this serious It should change the way we manage the situation.”

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