UPDATE, 26 FEBRUARY, 2024: This article has been updated following new findings into our landmark DiRECT study which have been published in the Lancet.
Results from a three-year extension of our landmark DIRECT study reveal that for some it’s possible to stay in remission of type 2 diabetes for at least five years. But the findings highlight that maintaining weight loss and staying in remission can be challenging.
New findings show that 13% of people who had received the weight management programme and continued to have support through the extension study were in remission of type 2 diabetes at five years.
Remission means blood sugar levels return to a non-diabetes range long term, without the need for diabetes medication.
The findings also show that the programme can have lasting benefits to health although in the extension period – three to five years on from receiving the ‘soups and shakes’ weight management programme – it was common for people to regain weight and fall out of remission.
The DiRECT extension was led by Professors Roy Taylor and Mike Lean (both pictured) and published in the Lancet.
Remission in the long term
The original DiRECT trial, which started in 2014, 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.
We funded the DiRECT extension study to help us understand more about the longer-term benefits of the programme.
In the extension study, the researchers followed participants from the original DiRECT intervention group – who had received the weight management programme – and the original control group – who hadn’t received the programme but did receive advice about managing their weight – for a further three years.
Some participants from the original intervention group opted to continue 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 latest remission results
At year five, remission data was available for 93 people from the original control group and 118 people from the original intervention group (including the 85 people who had continued to receive support from their GP during years 3-5).
12 out of 118 (10%) in the intervention group were still in remission at year five, compared to 5 out of 93 (5%) in the control group.
In the intervention group, of the 85 who had continued to receive support from their GP, 11 (13%) were still in remission.
At year five, the average weight loss in the intervention group was 5.6kg and in the control group this was 4.6kg.
For the 85 people in the intervention group who continued to receive GP support, the average weight loss was 6.1kg. The average weight loss of the 11 people in this group who stayed in remission was 8.9kg.
Over the whole five-year study period, people in the intervention group spent on average 27% of the time in remission. This compares to 4% for the control group who didn’t receive the weight management programme. The intervention group also spent more time with their bodyweight lower than baseline, off blood sugar lowering medications and with blood sugar levels in the non-diabetes range than the control group.
Benefits of remission and weight loss
While it's encouraging that the latest findings show that some people could stay in remission for five years, we also saw that this wasn’t possible for most. Many who regained the weight they had lost came out of remission. But it's important to remember that no matter how long you stay in remission for, spending any time in remission can have lasting benefits to health.
Another landmark remission study, called Look AHEAD, recently found that over a 12-year period going into remission at any point over the study was linked with a lower risk of heart and kidney complications, compared to never going into remission.
Staying in remission can be challenging. It is always possible that your blood sugar levels and weight can increase again, and you can go in and out of remission.
But even if you stay in remission for only a short time or don’t quite get there, by attempting it, a combination of lower blood sugar levels and lower body weight can bring significant health benefits. Putting weight back on and coming out of remission doesn’t mean that you’ve failed, you will have improved your health by trying and you might go back into remission again in the future.
People living with overweight or obesity on a weight management journey are fighting against their biology and the food environment. Over time, this complex interplay can make it difficult to avoid regaining weight. That’s why getting the right support to maintain weight loss and stay in remission is so important.
You can get more information on remission and its benefits.
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.
What's next?
Scientists have made significant strides in building our knowledge of dietary approaches to remission over the last decade, but it’s still a fairly new idea. There’s still much to learn so we can give more people the best chance to lose weight, maintain weight loss and stay in remission.
We’re proud that DiRECT’s findings have already influenced diabetes care, inspiring the NHS Type 2 Diabetes Path to Remission Programme. As this is rolled out across England we’ll get more valuable real-word data on weight loss, remission and its benefits for people newly diagnosed with type 2 diabetes.
We also need more research to understand how best to support people with type 2 diabetes to maintain weight loss and remission over time. And because a DiRECT style approach isn't suitable for everyone with type 2 diabetes, we need to find new or better routes to remission.
That’s why we’re investing in vital research like the 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.
Right now, we’re also calling on scientists to come up with research ideas and apply for our funding with proposals that will improve our understanding of, and support for people with type 2 who are seeking to go into or stay in remission.
Dr Elizabeth Robertson, our Director of Research, said:
“Diabetes UK is proud to have funded over a decade of research that has forged new frontiers for people with type 2 diabetes and put remission on the map.
“Remission from type 2 diabetes lifts the burden of 24/7 diabetes management and can transform health and wellbeing. But we know that going into remission can be challenging and staying there even more so. That’s why we’ve just launched our new remission information and support hub and are continuing to fund research to understand how to help more people go into remission and stay there for longer.”
Professor Mike Lean, at the University of Glasgow, said:
“DiRECT has made a world-wide paradigm-shift in understanding and treating type 2 diabetes. The disease is not necessarily permanent, and the five-year results now suggest that diet treatment for weight loss to achieve a period of remission is accompanied by greater freedom from some diabetes complications, and fewer people being admitted to hospital with medical problems.
“We must now call for much more effective, long-term funding for research to improve on these results – especially to prevent weight regain.”
Professor Roy Taylor, at Newcastle University, said:
“This five-year study demonstrates that long-term remission from type 2 diabetes is possible if sufficient weight loss is achieved and maintained.
“Whether or not remission of diabetes was achieved, those who were assigned to the weight loss group had less than half of the serious health issues experienced by the conventionally treated group. These are dramatic outcomes which should change how this serious condition is managed.”
