Physicians' Academy for Cardiovascular Education

First time randomized trial shows remission of T2DM with dietary and lifestyle intervention

Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial

Literature - Lean MEJ, Leslie WS, Barnes AC et al., - The Lancet, Available online 5 December 2017. https://doi.org/10.1016/S0140-6736(17)33102-1

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Main results

Conclusion

These results show that T2DM of up to 6 years’ duration can be reversed by weight loss with help of an evidence-based structured weight management program delivered in a community setting, by routine primary care staff. Almost a quarter of participants who followed the intervention achieved at least 15 kg of weight loss at 12 months, and half maintained at least 10 kg reduction. Almost half of patients in the intervention group showed remission of diabetes, and were off antidiabetic medication. Remission was closely related to the degree of weight loss maintained at 12 months. This cohort will be followed up for at least 4 years.

Editorial comment

To date, no findings from large-scale randomized trials were available on the effects of non-pharmacological treatment on remission of T2DM in patients receiving antidiabetic medication. Uusitupa [10] concludes that the obtained results are impressive and provide strong support for the view that T2DM is tightly associated with excessive fat mass in the body. These results, along with some other studies on T2DM prevention and some smaller intervention studies indicated that weight loss should be the primary goal in the treatment of T2DM, since it “results in improved insulin sensitivity in muscles and liver, decreases intra-organ fat content, and it might improve insulin secretion. In the long-term, weight loss might help to preserve β-cell mass. Once of the putative mechanisms could be decreased fat content of the pancreas, but more mechanistic studies are needed.” The role of physical activity and quality of diet, including dietary fibre and fatty acid composition are also important when considering the long-term success of prevention and treatment of T2DM.

The long-term results of the DiRECT study are important, because post-intervention weight regain is common among weight management studies in non-diabetic and diabetic populations. Uusitupa states “In view of the results of the DiRECT trial, a non-pharmacological approach should be revived. In clinical practice, anti- diabetic drugs seldom result in normalisation of glucose metabolism if patients’ lifestyles remain unchanged.”Uusitupa thinks that the time of diabetes diagnosis appears the best time point to start weight reduction and lifestyle changes, because the motivation of a patient is usually high.

References

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Download our slide set about this study Find this article online at The Lancet

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