Weight Management With Routine Primary Care Effective for T2D Control, Remission

A scale and tape measure
A scale and tape measure
The DiRECT study provides the first evidence from a randomized trial of a dietary and lifestyle intervention with remission of type 2 diabetes as a primary outcome.

An intervention consisting of lifestyle modification and weight management provides a more effective strategy for achieving remission from type 2 diabetes than guideline therapy, according to a study published in The Lancet.

A total of 49 primary care practices across Scotland and England were electronically randomly assigned to provide either a weight management program (intervention [n=23]) or best-practice care by guidelines (control [n=26]) for patients with type 2 diabetes.

Patients included in this study had a body mass index of 27 to 45 kg/m2 and were not receiving insulin therapy. In the intervention group, antidiabetic and antihypertensive drugs were discontinued and patients were given a 825- to 853-kcal/d formula diet for 3 to 5 months and provided support for sustaining long-term weight loss.

At 12 months, a significantly greater proportion of participants in the intervention group achieved ≥15-kg weight loss compared with the control group (24% vs 0%, respectively; P <.0001). In addition, more participants in the intervention group achieved diabetes remission at 1 year (46% vs 4%, respectively; odds ratio, 19.7; 95% CI, 7.8-49.8; P <.0001). None of the patients who gained weight during the study period achieved diabetes remission, whereas 86% who lost ≥15 kg went into remission.

The EuroQol 5 Dimensions visual analogue scale found a significantly greater quality-of-life improvement in the intervention group vs the control group (7.2 vs 2.9 points, respectively; adjusted difference, 6.4 points; 95% CI, 2.5-10.3; P =.0012). Abdominal pain and biliary colic were 2 serious adverse events that were possibly related to the weight management intervention.

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As this study included patients from Scotland and the Tyneside region of England, the findings may not be entirely generalizable to other population groups.

The researchers suggest that “low-intensity training and support of existing staff, and appropriate resource redistribution, could facilitate provision of this intervention” across health services, ultimately helping more patients achieve diabetes remission than seen in current clinical practice.


Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial [published online December 4, 2017]. Lancet. doi: 10.1016/S0140-6736(17)33102-1