Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

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

This Week's Must Reads

Acellular Pertussis Vaccine Is Safe & Effective, JAMA Pediatr; 2018 Nov; Wood, Nolan, et al

Influenza and Pertussis Vaccination in Pregnancy, Vaccine; ePub 2018 Nov 3; Wilcox, Bottrell, et al

Influenza Vaccine Efficacy in High-Risk Patients, Vaccine; ePub 2018 Nov 9; Shang, Chung, et al

Childhood Vaccination Coverage Rates Compared, J Paediatr Child Health; ePub 2018 Nov 13; Baumann, et al

Measles Immunity After Vaccination in Children with HIV, Clin Infect Dis; ePub 2018 Nov 12; Mutsaerts, et al

Must Reads in Diabetes

Rotating Night Shift Work & Risk of T2D, BMJ; ePub 2018 Nov 21; Shan, Li, et al

BMI & Risk of Postpregnancy T2D in Women with HDP , Diabetes Care; ePub 2018 Nov 19; Timpka, et al

Diabetes Outcomes in Patients by PCPs, NPs, or PAs, Ann Intern Med; ePub 2018 Nov 20; Jackson, et al

Diabetes-Related Lower Extremity Amputations, Diabetes Care; ePub 2018 Nov 8; Geiss, et al

Peer Support Impact in Adults with T2D & Depression, Diabetes Care; ePub 2018 Oct 29; Cherrington, et al