Can type 2 diabetes go into remission, and what did the DiRECT trial really show?
In a 2018 trial, 46% of people on an intensive weight management programme were in remission of type 2 diabetes after a year, off diabetes drugs; at two and five years the picture was more modest.
▶ Start the storyYes, type 2 diabetes can go into remission for some people, as the DiRECT trial showed. It ran in 49 primary care practices in Scotland and the Tyneside region of England, and the practices were randomly assigned to provide either a weight management programme or best-practice care by guidelines. It enrolled people aged 20 to 65 who had been diagnosed with type 2 diabetes within the past 6 years and were not receiving insulin. The programme withdrew diabetes and blood pressure drugs, used a formula diet of 825 to 853 kcal a day for 3 to 5 months, then reintroduced food in steps with support to keep the weight off. Remission meant an HbA1c below 6.5% (48 mmol/mol) after at least 2 months off all diabetes medicines.
At 12 months, remission was achieved in 68 (46%) of the programme group and 6 (4%) of the control group. Remission varied with weight loss: none of the 76 participants who gained weight were in remission, versus 31 (86%) of the 36 who lost 15 kg or more.
At 24 months the figure was 53 (36%) of the programme group against five (3%) of the control group. A 5-year extension then followed the participants who continued with lighter support: 11 (13%) of the 85 extension participants were in remission, and of those in remission at year 2, 26% remained so at 5 years.
Remission in the DiRECT trial
| Programme group | Control group | |
|---|---|---|
| 12 months | 46% | 4% |
| 24 months | 36% | 3% |
So a fair summary is: remission happened in a substantial share of a particular group, tracked weight loss, and became less common with longer follow-up. The group was selected (diagnosed within 6 years, not on insulin). An expert group convened by the American Diabetes Association adds that the long-term risks versus benefits of remission are not well understood. This describes trial results, not advice for any person.
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Recap
In DiRECT, remission tracked how much weight was kept off, and became less common as follow-up lengthened.
💡 A trick to remember it · Remission rode on the kilos kept off: 46% at one year, 36% at two.
Surprising fact · An expert panel said the long-term risks versus benefits of attaining remission are not well understood.
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Sources (4)
No source, no claim. Every fact in this lesson (16 claims) cites at least one of these.
- [1]Primary care-led weight management for remission of type 2 diabetes (DiRECT): 12-month results (2018) · Europe PMC (journal abstract)
- [2]Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of DiRECT (2019) · Europe PMC (journal abstract)
- [3]5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study (2024) · Europe PMC (journal abstract)
- [4]Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes (2021) · Europe PMC (journal abstract)