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The DiRECT route to Type 2 remission?

Project summary

The DiRECT (DIabetes REmission Clinical Trial) study: Remission of Type 2 diabetes using non-surgical weight management with low-energy liquid diet and long-term maintenance within routine NHS care

With support from our largest ever research grant, Professors Mike Lean and Roy Taylor will investigate if a low-calorie diet, alongside weight management support, can put Type 2 diabetes into remission for the long-term. 

Their vital work will find out if a low-calorie, diet-based treatment should be offered as a routine treatment for Type 2 diabetes. In the future, this could help to reduce the number of people living with Type 2 diabetes.

Get all the latest news on how the low-calorie diet research is going so far.

Background to research

Not everyone with Type 2 diabetes is overweight, but obesity is a key risk factor. Weight loss surgery had already been shown to put Type 2 into remission in some people. But surgery is invasive, has risks of complications and isn't available to everyone.  

In 2011, we funded a ground-breaking study at Newcastle University that tested a new approach to weight management. And aimed to work out why this might be able to put Type 2 into remission. 

Under close supervision from a medical team, 11 people with Type 2 diabetes went on a diet of around 800 calories a day for eight weeks. After this low-calorie diet, participants had reduced the amount of fat in their liver and pancreas. And the amount of insulin they produced at mealtimes had returned to normal.

After two months, everyone who took part in the study was in remission from Type 2 diabetes. And three months later, most still had normal blood glucose control.

Another study, involving 30 people with Type 2 diabetes, confirmed these findings and showed people could stay in remission for six months after the low-calorie diet was completed. It also suggested that the diet was effective in people that had Type 2 diabetes for up to 10 years.

To build on the success of this trial, we called for new research ideas to find out if this approach can be used safely as part of long-term weight management within routine GP care, to help put Type 2 diabetes into remission and keep it there.

Research aims

Researchers led by Professor Mike Lean at the University of Glasgow and Professor Roy Taylor at Newcastle University will compare a low-calorie diet, alongside weight management support, with the best Type 2 diabetes care that is currently available.

People aged 20 to 65 who are overweight and have been diagnosed with Type 2 diabetes in the last six years of starting the study will be recruited from their GP practices across Scotland and Tyneside. Half the participants will receive an intensive low-calorie, diet-based, weight management programme, and the other half will receive the best weight loss support currently available.

Those on the low-calorie diet will have around 800 calories a day, made up of soups and shakes, plus lots of fluids. The diet will last for between 8 and 20 weeks. After this, they'll be gradually re-introduced to normal food and will receive expert support to help them maintain their weight loss.

Some of the participants will also have scans of the inside of their bodies to help the researchers understand exactly how rapid weight loss can lead to Type 2 diabetes remission. The researchers will also look at the opinions of people with Type 2 diabetes and healthcare professionals who take part in the study. This will help them identify challenges and work out how this programme might be used most effectively in routine GP care.

Potential benefit to people with diabetes

If this study shows that weight management support using a low-calorie diet can help people put their Type 2 diabetes into remission, it could completely change the way that Type 2 diabetes is viewed and treated by the NHS. It could also help us understand more about the biology of Type 2 diabetes and remission.

DiRECT will help us work out if a treatment of this kind should offered to people with Type 2 diabetes in the future. Ultimately, it could benefit the millions of people living with Type 2 diabetes and help them live well for longer.

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