To explore the potential for a low-calorie diet (LCD, >800kCal/day) to put T2D into remission, NHS England is currently embarking on a restricted calorie trial with 5,000 people. NHS Scotland is also providing funding for NHS Boards to deliver diabetes remission programmes.20,21

Schemes are based on scaling up the DiRECT trial funded by Diabetes UK which looked at the impact of the LCD as well as the impact of having ongoing dietary support from healthcare professionals. It recruited 300 patients from 49 primary care practices in Scotland and Tyneside who met the following criteria:22,23,24

·       aged 20–65 years

·       diagnosed with T2D within the past 6 years

·       BMI of 27–45 kg/m2

·       not receiving insulin.

The main feature of the programme was for patients to go on a liquid meal replacement LCD of 825–853 kCal/day for three to five months, before gradually reintroducing food over the next two months.

In addition, patients stopped using antidiabetic and antihypertensive medication, and were given structured support for long-term weight loss maintenance. Patients in the control group were just given support for best-practice care following existing guidelines.24

After 12 months, 36 out of 149 patients in the LDC cohort had lost 15kg or more, whereas none of the control group participants had recorded such a weight loss.

Diabetes remission was taken as having an HbA1c of less than 6.5% (<48 mmol/mol) after at least two months off all antidiabetic medications, from baseline to 12 months. The study found that 46% of the LDC intervention group compared to 4% of the control group participants had achieved diabetes remission.

Data indicated that the longer the person had had a T2D diagnosis, the less likely was the chance of remission under the programme. Remission also varied with weight loss. While there was no diabetes remission in any of the 76 participants who had gained weight, the proportion achieving remission with weight loss were:

·       7% who maintained 0-5kg weight loss

·       34% with 5-10kg loss

·       57% with 10-15kg loss

·       86% with a 15kg or greater loss.

Overall, at 12 months, almost half of participants had achieved remission and were off antidiabetic drugs, indicating that “remission of T2D is a practical target for primary care.”