T2D remission: DiRECT-Aus same as original UK DiRECT

[Eddy Edson]

Brief read-out from the Australian recreation of the original DiRECT trial. Amazingly, the results were the same.

I queried early in this trial why it was necessary to repeat the UK study, without adding anything about eg trying to better identify responder phenotypes; broaden to include a non-overweight ReTUNE population; or anyway something which adds to existing knowledge. But no response. Maybe it was a box which needed to be ticked for Medicare coverage of a DiRECT program in Australia or something.

On that point, it also doesn't do anything to address the key clinical point: most people don't sustain weight-loss over the medium/long term and so most don't sustain remission. (No, a low-carb approach doesn't do any better; no lifestyle approach does.)

Intensive Lifestyle Intervention for Remission of Early Type 2 Diabetes in Primary Care in Australia: DiRECT-Aus

OBJECTIVE. We aimed to assess whether remission of type 2 diabetes (T2D) could be achieved with a low-energy total diet replacement (TDR) in an Australian

diabetesjournals.org

 

[Eddy Edson]

At the recent EASD conference there was a debate between Roy Taylor and Prof Kamlesh Khunti I'd like to have seen: "Is lasting diabetes [T2] remission possible in a real world setting?" With Khunti taking the negative.

Partha Kar chimed in on a twitter thread:

https://twitter.com/x/status/1709781079635194126

https://twitter.com/x/status/1709803568067211682

Would be interesting to hear how the new weight loss meds fit into his view.

 

[Burylancs]

Brief read-out from the Australian recreation of the original DiRECT trial. Amazingly, the results were the same.

I queried early in this trial why it was necessary to repeat the UK study, without adding anything about eg trying to better identify responder phenotypes; broaden to include a non-overweight ReTUNE population; or anyway something which adds to existing knowledge. But no response. Maybe it was a box which needed to be ticked for Medicare coverage of a DiRECT program in Australia or something.

On that point, it also doesn't do anything to address the key clinical point: most people don't sustain weight-loss over the medium/long term and so most don't sustain remission. (No, a low-carb approach doesn't do any better; no lifestyle approach does.)

Intensive Lifestyle Intervention for Remission of Early Type 2 Diabetes in Primary Care in Australia: DiRECT-Aus

OBJECTIVE. We aimed to assess whether remission of type 2 diabetes (T2D) could be achieved with a low-energy total diet replacement (TDR) in an Australian

diabetesjournals.org

View attachment 27936

Unsurprisingly the results were not the same. 47% in Direct study achieved this so-called Remission after a year. 56% of the Aussie study did. Clearly a 19% difference (9/47 x 100) is not 'the same'.

 

[Dragonheart]

On that point, it also doesn't do anything to address the key clinical point: most people don't sustain weight-loss over the medium/long term and so most don't sustain remission. (No, a low-carb approach doesn't do any better; no lifestyle approach does.)

Is there long term large scale evidence (eg a direct trial of low carb?) to show low carb doesn’t work that you can link to or is that your personal opinion? Lack of evidence is not the same as evidence of lack.

 

[everydayupsanddowns]

Is there long term large scale evidence (eg a direct trial of low carb?) to show low carb doesn’t work that you can link to or is that your personal opinion? Lack of evidence is not the same as evidence of lack.

Has the lowcarb GP published a paper? Or is that all anecdotal reporting?

 

[Dragonheart]

Has the lowcarb GP published a paper? Or is that all anecdotal reporting?

he certainly is named on papers. Couldn’t say off hand which ones. My question was a little tongue in cheek and rhetoric.
I’m pretty sure there isn’t such a paper or study of properly low carb (not just slightly reduced carb) or keto done in a similar way and duration as the direct trials let alone a conclusion that says it doesn’t work long term - though I’m happy to be corrected so the question wasn’t entirely pointless. The virta studies are possibly the largest and closest which did show successes. It’s not really in industries financial benefits to reduce the ever ready supply of high carb foods or allow the guidance to be changed. And industry is where a lot of funding comes from for these studies and who sits on so many of the nutritional advisory boards etc. And that is without considering the political (in the broader sense not party specific) impact of admitting the guidance has been wrong for years telling type 2 to base their meals on starchy carbs

 

[Eddy Edson]

Is there long term large scale evidence (eg a direct trial of low carb?) to show low carb doesn’t work that you can link to or is that your personal opinion? Lack of evidence is not the same as evidence of lack.

The nearest thing to a rigorous long-term low-carb study for T2D remission that I know of is Virta's report on its observational study at the 5 year mark. As far as I know the results from this haven't been published in a peer-reviewed journal, just in a PR: https://forum.diabetes.org.uk/board...aybe-about-as-good-as-weight-watchers.100474/

About 10% remission at the 5 year mark on an ITT basis, so comparable to DiRECT I think.

The results probably track the weight loss outcome, and there are approximately one gadzillion studies showing no big difference between dietary/lifestyle approaches for weight loss. I guess Chris Gardner's classic DIETFITS study https://pubmed.ncbi.nlm.nih.gov/29466592/ is a good place to start, together with its various secondary analyses, extansions etc.