How the DiRECT study could make Type 2 diabetes remission entirely possible in GP care – by Dr Farooq Ahmad
The DiRECT trial was funded by Diabetes UK to study the effects of a structured weight management programme on long-term Type 2 diabetes remission. It involved people with Type 2 diabetes and was tested across 49 GP practices in Scotland and Tyneside. Half of the participants received the new treatment, while the other half received routine Type 2 diabetes care (control group).
The weight loss treatment involved a low-calorie liquid diet, followed by longer-term support to reintroduce normal food and maintain weight loss.
The results were fantastic at 12 months, showing that 24 per cent who tried the new weight management approach lost 15kg or more. In comparison, no one in the control group lost that much weight.
Even more excitingly, Type 2 diabetes remission was achieved by 46 per cent of participants trying the low-calorie diet programme. With remission found to be closely related to weight loss. 86 per cent of people who lost more than 15kg on the programme were in remission after a year.
A sense of hope
To me, working in General Practice in South London, where we have a high risk of Type 2 amongst my practice population, Type 2 diabetes presents as a growing and serious problem. The DiRECT study not only offers hope to me as a GP, but offers real possibility of remission of Type 2 diabetes for my patients.
As a GP, it can feel there’s a sense of inevitability of prescribing more and more medications to my patients with Type 2 diabetes. And in turn this can cause an increased reliance from the health service on using drugs to treat the condition. But DiRECT addresses assumptions about Type 2 diabetes, both amongst patients as well as clinicians, by showing it isn’t always a progressive condition.
This can give hope to patients of becoming free from taking regular medications, sometimes twice or three times daily. And could allow them to live healthier lives, benefiting not only from remission of Type 2 diabetes, but also from the effects of weight loss and physical activity.
Financially, this study offers great hope to the cash strapped NHS to start looking at commissioning weight loss activity through a structured and supported way. It could potentially lead to massive savings, through reduced prescribing of medications and lowered risk of diabetes complications.
What could this mean for primary care?
What’s more, DiRECT makes me optimistic that use of a structured weight-loss programme to bring about Type 2 diabetes remission is entirely possible in GP care. For me, it highlights that we need to start seeing a concerted effort from public health to rethink our strategy, around not only prevention of Type 2 diabetes, but also putting it into remission.
To do this, there’s a need for public health to work in partnership with GP surgeries and community healthcare professionals, like diabetes nurses and dieticians. It’s something that would require appropriate funding channelled into training GPs and practice nurses so we can support our patients to do this.
Importantly, the DiRECT trial isn’t finished yet and there’s still work to be done to establish a robust body of evidence on the effectiveness of this programme.
Nonetheless, it’s become clear to me that some patients will want to try this approach now. However, only last week, when a patient of mine with Type 2 diabetes approached me to support her with a low-calorie diet, I had no services available to me to refer her to.
I hope in the months and years ahead, locally and at scale, we start discussions around diverting the funds, which have previously been ploughed into medications and complications costs of Type 2 diabetes, into prevention and remission of this condition.
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