DiRECT Trial & NHS-funded Low-Carb Diets Show Promising Results for Diabetes Remission

Plan Diet Replacements and Activities with a Dietitian

​Wouldn’t it be a dream-come-true if a diabetic becomes a non-diabetic, at least for some specific period of time? That’s what the DiRECT trial is all about. The phenomenon where individuals with type 2 diabetes become non-diabetics is called ‘diabetes remission.’ In diabetes remission, most individuals become free from medications and enjoy normal blood glucose levels. Let’s look into the details of this trial to get a clearer picture about diabetes remission.
 
DiRECT Trial
 
An open-ended, controlled trial that had participants from primary care practices all over UK, DiRECT trial included only those who suffered from type 2 diabetes for less than 6 years. The primary focus of this trial was to understand whether or not a structured, intensive, weight-management program was an effective treatment method for type 2 diabetes.
 
The interventions used included withdrawing any use of antidiabetes and antihypertensive drugs, replacing the diet completely (an 825-853 kcal/day formula diet for around 12-20 weeks), reintroducing foods in a stepped manner (2-8 weeks), and providing support for sustaining the weight loss.
 
The results at the end of the 12-month period showed that almost 50% of the participants achieved remission freeing themselves from diabetes and stopping antidiabetes drugs. Almost a third of the participants sustained remission at 24 months. The extent of remission was purely based on the extent to which the participants sustained weight loss.
 
Though not a ‘panacea’ of treatment, this trial provides a new dimension to approaching type 2 diabetes treatment. It motivates individuals to make diet modifications and lifestyle changes right from an early stage of diagnosis. The trial aims to help patients free themselves from the limitations placed by diabetes on their daily living and reduce the risk of diabetes-related complications.
 
Besides weight loss, DiRECT helped participants improve several conditions including psoriasis, allergies, and symptoms of irritable bowel syndrome.
 
NHS-sponsored Low-calorie Programs
 
The positive results of the DiRECT trial motivated NHS to provide free access to a low-calorie-diet program for 5000 people across England. The participants here were provided with a 3-month total-diet replacement products that included shakes and soups. All normal meals were completely replaced with a 900-calorie/day replacement foods for up to 12 weeks. During this period, they were motivated to increase their exercise levels alongside support provided for the same. Once weight loss was achieved, solid foods were reintroduced periodically and weight-loss maintenance guidance was done.
 
The DiRECT trial is still in an ongoing phase and the participants would be monitored for a 7-year period totally to understand how individuals are able to maintain weight loss and remission.
 
A Word of Caution
Never try doing such low calorie diets on your own and it is never recommended to go into this mode as a quick fix for weight loss and diabetes correction. All the participants in the DiRECT trial as well as the NHS-funded low-calorie-diets were guided by expert healthcare professionals right through the program. There were a number of participants who found this experience challenging—a word of caution here, this type of weight loss and remission is not for all. Get in touch with a dietitian/nutritionist, seek medical support and then decide to go on a weight-loss program (if needed) to achieve diabetes remission.
 
The DiRECT team is testing yet another trial called RETUNE where normal-weight people with diabetes can achieve remission. Dietitians play an integral role in all these trials following up on all the three important phases—total diet replacement, food reintroduction, and weight loss management. The team is yet to figure out the benefits of diabetes remission in protecting individuals against diabetes-related complications in the later stages of life.
 
Conclusion
 
The DiRECT trial and the NHS-funded program clearly confirm that weight loss and diet modifications are crucial for controlling and putting diabetes into remission. There have been individuals who have been in remission for more than 15 years with diet changes, physical activities, and lifestyle modifications. When this is clearly evident, what’s the need for minute-by-minute monitoring of blood glucose levels, going around with CGM, or having an accu-chek handy unless the situation demands? Let’s simplify the course of action and reap beneficial results with straightforward plans and executions. Never pay heed to humongous promises that showcase stuff in a mammoth way unnecessarily.