What are the key components of the DiRECT weight management programme and what were the remission rates at 2-year follow-up?

The DiRECT programme is a primary care-led intensive weight-management intervention involving total diet replacement of 825–853 kcal/day for 3–5 months, followed by stepped food reintroduction and structured support for long-term weight-loss maintenance, for people with type 2 diabetes diagnosed within the previous 6 years. At 2-year follow-up, 65% of those who maintained at least 10kg weight loss were still in remission, but only 24% of the intervention group maintained that level of weight loss.

DiRECT is described as a structured primary care-led intensive weight management programme. Its components are: a total diet replacement providing 3452–3569 kJ/day (825–853 kcal/day) for 3–5 months, followed by stepped food reintroduction, and structured support for long-term weight loss maintenance, targeting people diagnosed with type 2 diabetes within the previous 6 years. The trial demonstrated greater remission rates than standard diabetes care, and the likelihood of remission depended on the amount of weight lost. At 2-year follow-up, 65% of participants who maintained more than 10kg weight loss were more likely to still be in remission. However, only 24% of the intervention group maintained at least 10kg weight loss, illustrating both the potential of weight loss for remission and the difficulty of sustaining it long term.