Changing the paradigm for Type 2 diabetes remission in the UK
Type 2 diabetes (T2D) affects 3.4 million people in the UK. The disease was traditionally considered permanent and inevitably progressive. However, in 2018, the Diabetes Remission Clinical Trial (DiRECT; funded by the charity Diabetes UK) showed for the first time, in a real-world UK primary care setting, that sustainable remission of T2D can be attained through weight loss. The University’s Professor Mike Lean designed and co-led DiRECT alongside Professor Roy Taylor of Newcastle University, with Glasgow coordinating the study. Glasgow research also provided the clinical basis for the DiRECT intervention, which comprised a 12-week low-calorie diet followed by phased food re-introduction with structured support from trained dietitians. In the study, around half of all participants randomly assigned to the intervention achieved T2D remission in the first 12 months, with over one-third of participants showing sustained remission at 24 months. Within 1 year of the primary results, DiRECT had changed understanding, practice and policy at national and international levels. UK diabetes professional bodies and treatment guidelines have now designated remission as a treatment target, with remission a core strategy of Diabetes UK. NHS Scotland has implemented the approach across all 14 health boards, and NHS England launched the NHS Low Calorie Diet programme for 5,000 patients. DiRECT-based remission clinics are being implemented internationally and have entered international clinical guidelines. Over a dozen commercial providers now also deliver T2D remission programmes based on DiRECT.