Our DiRECT study changed the game when it showed that type 2 diabetes remission is possible for some through diet-induced weight loss. Now, new results from an extension of DiRECT reveal that for some it’s possible to stay in remission for at least five years.
New findings from a three-year extension of our landmark DIRECT study show that nearly a quarter (23%) of participants who were in remission from type 2 diabetes at two years in the original trial remained in remission at five years.
This means they no longer needed to use diabetes medications to manage their blood sugar levels.
The number of participants in type 2 diabetes remission after five years was more than three times that of the DiRECT control group, who didn’t take part in the original ‘soups and shakes’ weight management programme.
The findings will be presented next week by DiRECT researchers Professors Roy Taylor and Mike Lean (both pictured) at our Professional Conference (DUKPC).
Remission in the long term
The original DiRECT trial ran for two years. Previous results showed that almost half (46%) of people with type 2 diabetes who received the weight management programme were in remission one year later, and 36% at two years.
To help us understand more about the longer term benefits of the programme, we carried on funding DiRECT for a further three years.
In the extension study, 95 participants from the original intervention group who had received the weight management programme continued to receive support and advice from their GP surgery to help them maintain weight loss over the next three years.
Anyone who regained more than 2kg during the three years was offered an additional package of support. This consisted of the low-calorie ‘soups and shakes’ diet for four weeks and support to reintroduce normal meals.
The researchers also looked at data from 82 participants who were part of the original DiRECT control group. Participants in the control group didn’t receive the ‘soups and shakes’ programme in the original DiRECT trial and didn’t get follow up weight loss maintenance support from their GP surgery.
The latest results
- Data, which was available from 85 participants of the original DiRECT intervention group, revealed an average 5-year weight loss of 6.1kg
- 48 out of 85 people from the intervention group were in remission at the start of the three-year extension study. 11 out of 48 of these (23%) were still in remission at five years, and their average weight loss was 8.9kg
- This compares to an average 5-year weight loss of 4.6kg, with 3.4% in remission, for those in the control group
- Overall, the extension intervention group saw greater improvements in blood pressure and blood sugar levels and had fewer needed medication than the control group.
Benefits of remission and weight loss
The DIRECT study findings support growing evidence that weight loss, and remission from type 2 diabetes, can prevent or delay the complications of diabetes. And while it's encouraging that some people could stay in remission for five years, we also saw that those who regained the weight they had lost, came out of remission.
This drives home that remission is not a quick fix for type 2 diabetes. Maintaining weight loss and staying in remission can be really challenging. We’ve always known that remission is not a one-off, once and for all event. It’s a ongoing process and it is always possible that blood sugars levels can rise again.
But no matter how long people can stay in remission for, spending extra time with blood sugars levels below the diabetes range can have lasting benefits to health.
It's also important to keep in mind that even if people don’t go into remission, weight loss has significant health benefits. We know that losing even 5% of your weight helps improve blood pressure and cholesterol levels. This can have a big impact on your overall health and go a long way to reducing your risk of serious complications.
Losing weight can improve your blood sugar levels too, even if they don’t go below the diabetes range, by helping your body to better respond to the insulin you’re making. This could mean you need fewer diabetes medications or lower doses.
Kieran Ball was diagnosed with type 2 diabetes in 2013 and started DiRECT the following year. Kieran lost 22kg and put his type 2 diabetes into remission in the first year of the study. Having taken part in the DiRECT extension, he is still in remission today. Kieran said:
“DiRECT has 100% been life changing. Those few months on the low-calorie diet were hard, but I’d do it again no question. DiRECT was an opportunity to reboot the way I was living and I’m so grateful for what being healthy has given me the opportunity to do. It’s amazing that what I went through all those years ago is still benefiting me today. I’m still in remission and not on any diabetes medication – I can’t quite believe how long it has been.”
Read Kieran’s story.
Dr Elizabeth Robertson, our Director of Research, said:
“Diabetes UK is proud to be at the forefront of over a decade of pioneering research into type 2 diabetes remission. Our DiRECT study has been pivotal in transforming the lives of people with type 2 diabetes by showing that the condition can be put into remission through weight loss. The new findings from DiRECT confirm that for some people, it is possible to stay in remission for at least five years.
“For those who put type 2 diabetes into remission, it can be life-changing, offering a better chance of a healthier future. For those that aren’t able to go into remission, losing weight can still lead to major health benefits, including improved blood sugar levels, and reduced risk of serious diabetes complications such as heart attack and stroke.
“DiRECT inspired the NHS low-calorie diet programme, granting many more people with type 2 diabetes the opportunity to put the condition into remission. We now need to understand how best to support more people to maintain weight loss and stay in remission in the long term.”
Professor Mike Lean, at the University of Glasgow, said:
“The findings are important both for individuals and for national considerations of healthcare costs. The programme used in DiRECT is a huge improvement on previous management of type 2 diabetes, but future studies must seek even better ways to help maintain weight loss.”
Professor Roy Taylor, at Newcastle University, said:
“The DiRECT five-year follow up shows that the rapid weight loss programme brings about considerable weight loss at five years with low-intensity support. The most important question now is how the follow-up programme can be even more successful at an affordable cost.”
What's next?
We know a DiRECT style approach isn't suitable or doesn't work for everyone with type 2 diabetes. That's why we're continuing to invest in research to find more routes to remission and give more people the best chance to lose weight, maintain weight loss and stay in remission.
This includes our NewDAWN study. Our researchers are developing a new nationwide NHS support service that will offer a range of weight loss diets for people with overweight or obesity and newly diagnosed with type 2 diabetes. We hope it will help everyone who could benefit find an approach that suits them, and have the opportunity of time free from type 2 diabetes.
