Type 2 Diabetes Remission - UK Direct Trial update.

Diabetes UK have been publicising unpublished results from a 5 year follow-up of the DiRECT trial where a harsh calorie restriction diet ((825–853 kcal/day formula diet for 3–5 months)) was used to attempt remission of Type 2 diabetes in obese and overweight adults. 85 subjects from the initial intervention group of 149 were included in the follow-up.

After 5 years, 11 people were still in remission with a mean weight loss of 6.1 kg. This compares to an average 5-year weight loss of 4.6kg, with 3.4% in remission, for those in the control group.

At the 3 year point 48 of the 85 had been in remission, so only 23% had sustained remission from years 2-5. The percentage in remission in this group fell from 56.5% to 13%.

After the first year of DiRECT, remission was seen in 68 out of 149 subjects, or 46%. Follow up after the second year reported that 53 of the original 149 were still in remission, or 36%.

This suggests that the 85 people in the extension study had a higher success rate at the outset than the whole intervention group. Even if we scale up the 13% in remission at year 5 from 85 to the original 149 it would suggest 19 long term successes in total.

The other primary goal of DiRECT was to achieve a 15 kg weight loss, not least because remission is much higher if this level of loss is achieved. Despite the severity of the calorie restriction and the amount of support provided only 36 (24%) of original participants achieved this at one year, falling to 17 (11%) after 2 years. The Diabetes UK press release does not appear to clarify how many of the 85 had sustained a 15 kg weight loss at year 5, but reports a mean weight loss in the group of 6.1 kg at year 5 compared to 10 kg in the whole intervention group at the end of the first year.

Dr Nicola Guess has written an article suggesting that there is merit in looking at the macronutrient content of the diet beyond the energy balance, as studies show that liver and pancreas fat can be reduced by carbohydrate reduction without weight loss due to the change in fat use for energy and reducing denovo lipogenesis from high carbohydrate intake. This could improve the success rate and reduce the regression seen in DiRECT where weight loss proves hard to achieve and harder to sustain.