Clinical Edge

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Weight Management & Remission of T2D in Primary Care

Lancet; 2018 Feb; Lean, Leslie, Barnes, et al

Nearly half of patients with type 2 diabetes (T2D) in a primary-care led weight management program achieved remission to a nondiabetic state and off antidiabetic drugs at 12 months, a recent study found. The open-label, cluster-randomized trial (DiRECT) included 49 primary care practices which were randomly assigned 1:1 to provide either a weight management program (intervention) or best-practice care by guidelines (control). 306 individuals were recruited between July 25, 2014, and August 5, 2017 from 49 intervention (n=23) and control (n=26) general practices; 149 participants per group comprised the intention-to-treat population. Researchers found:

  • At 12 months, weight loss of ≥15 kg was recorded in 36 (24%) participants in the intervention group and no participants in the control group.
  • Diabetes remission was achieved in 68 (46%) participants in the intervention group and 6 (4%) in the control group (OR, 19.7).
  • Remission varied with weight loss in the entire study population, with achievement in none of 76 participants who gained weight, 6 (7%) of 89 who maintained 0-5 kg weight loss, 19 (34%) of 56 with 5-10 kg loss, 16 (57%) of 28 with 10-15 kg loss, and 31 (86%) of 36 who lost ≥15 kg.

Citation:

Lean MEJ, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): An open-label, cluster-randomised trial. Lancet. 2018;391:541-551. doi:10.1016/S0140-6736(17)33102-1.

Commentary:

This study shows very nicely that a significant proportion of patients who have had type 2 diabetes for up to 6 years can achieve remission of their diabetes with diet. It must be noted that this is not easy and the diet used was a severely restrictive one, with the use of an 850 kcal per day formula diet for the first 3 months. That said, the fact that almost half of patients in the diet group had such remission is an important achievement both for the individuals who benefited and for our understanding of what is possible for diabetes remission. —Neil Skolnik, MD

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