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DiRECT study: 23% of participants remained in T2DM remission at five years

The latest results from a three-year extension of the DiRECT study reveal that for some people it’s possible to stay in remission from T2DM for at least five years (no longer needed to use diabetes medications to manage their blood sugar levels). The results found that that nearly a quarter (23%) of participants who were in remission from T2DM at two years in the original trial remained in remission at five years. The number of participants in T2DM remission after five years was more than three times that of the DiRECT control group, who didn’t take part in the original ‘soups and shakes’ weight management programme.  

Roy Taylor

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

The original DiRECT trial ran for two years. Previous results showed that almost half (46%) of people with type 2 diabetes who received the weight management programme were in remission one year later, and 36% at two years. To help the researchers understand more about the longer term benefits of the programme, they carried on funding DiRECT for a further three years.

In the extension study, 95 participants from the original intervention group who had received the weight management programme continued to receive support and advice from their GP to help them maintain weight loss over the next three years. Anyone who regained more than 2kg during the three years was offered an additional package of support. This consisted of the low-calorie ‘soups and shakes’ diet for four weeks and support to reintroduce normal meals.

The researchers also looked at data from 82 participants who were part of the original DiRECT control group. Participants in the control group didn’t receive the ‘soups and shakes’ programme in the original DiRECT trial and didn’t get follow up weight loss maintenance support from their GP surgery. Data, which was available from 85 participants of the original DiRECT intervention group, revealed an average five-year weight loss of 6.1kg.

A total of 48 people from the original intervention group were in remission at the start of the three-year extension study. 11 of these (23%) were still in remission at five years, and their average weight loss was 8.9kg. This compares to an average five-year weight loss of 4.6kg, with 3.4% in remission, for those in the control group. Overall, the extension intervention group saw greater improvements in blood pressure and blood sugar levels and had fewer needed medication than the control group.

“The findings are important both for individuals and for national considerations of healthcare costs,” added Professor Mike Lean, at the University of Glasgow. “The programme used in DiRECT is a huge improvement on previous management of type 2 diabetes, but future studies must seek even better ways to help maintain weight loss.”

The DIRECT study findings support growing evidence that weight loss, and remission from T2DM, can prevent or delay the complications of diabetes. Plus, weight loss has many health benefits even if people don't go into remission.

“Diabetes UK is proud to be at the forefront of over a decade of pioneering research into type 2 diabetes remission. Our DiRECT study has been pivotal in transforming the lives of people with type 2 diabetes by showing that the condition can be put into remission 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,” added Dr Elizabeth Robertson, Director of Research at Diabetes UK. “For those who put type 2 diabetes into remission, it can be life-changing, offering a better chance of a healthier future. For those that aren’t able to go into remission, losing weight can still lead to major health benefits, including improved blood sugar levels, and reduced risk of serious diabetes complications such as heart attack and stroke. DiRECT inspired the NHS low-calorie diet programme, granting many more people with type 2 diabetes the opportunity to put the condition into remission. We now need to understand how best to support more people to maintain weight loss and stay in remission in the long term.” 


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