Translation of a Diabetes Remission Service into Australian Primary Care: Findings from the Evaluation of DiRECT-Australia

Background. The Diabetes Remission Clinical Trial (DiRECT) study demonstrated that an intensive and structured weight management program in UK primary care resulted in high rates of diabetes remission in adults with recent onset type 2 diabetes mellitus (T2DM). This study was aimed at evaluating the translation of the DiRECT intervention into an Australian primary care setting. Methods. All patients enrolled in the DiRECT-Australia Type 2 Diabetes Remission Service in a region of Sydney (Macarthur region, South Western Sydney, Australia) were included. Eligible participants were aged 20–70 years, noninsulin treated, with T2DM of ≤6 years’ duration, and body mass index BMI≥27 kg/m2. Total diet replacement of 825-853 kcal/day using meal replacements was implemented for 12 weeks, followed by an ongoing structured program until 52 weeks, with regular follow-up with a general practitioner, dietitian, and/or practice nurse. Results. Of 39 recruited participants, 32 (82.1%) and 27 (69.2%) completed 12 weeks and 52 weeks of the structured program, respectively. Decrease in weight by -12.0 kg (95% CI: -9.6, -14.4; p<0.001) and -9.1 kg (95% CI: -5.2, -12.9; p<0.001) and decrease in glycated haemoglobin (HbA1c) by -1.1% (95% CI: -0.6, -1.6; p<0.001) and -0.6% (95% CI: -0.1, -1.1; p=0.013) were observed at 12 and 52 weeks, respectively. At the end of 12 and 52 weeks, 93.8% (30/32) and 55.6% (15/27) of those with follow-up data met the criteria for diabetes remission, respectively. Quality of life and wellbeing scores increased over the course of 12 weeks, remaining significantly higher at 52 weeks. Participants reported they would be willing to pay A$92.50 (95$75.80, A$109.30) per fortnight for the low-calorie meal replacement shakes. Conclusions. These findings support the feasibility of a structured diabetes remission service in an Australian primary care setting to achieve improvements in glycaemia, weight, and quality of life and wellbeing, and suggest a substantial willingness to pay for diet replacement products among participants

Evaluation of the DiRECT-Australia type 2 diabetes remission service

Background: The Diabetes REmission Clinical Trial (DiRECT) study demonstrated that a program including intensive structured total diet replacement (TDR) in UK primary care resulted in high rates of diabetes remission in adults with recent onset type 2 diabetes (T2DM). This study aimed to assess the effectiveness of implementing the DiRECT intervention within a primary care setting in Australia. Methods: Participants were all patients enrolled in the DiRECT-Australia T2DM Remission Service in South Western Sydney, aged 20-70 years, non-insulin treated, with T2DM duration ≤6 years, and body mass index (BMI) ≥27kg/m². The intervention comprised an 800 Kcal/day TDR program for 12 weeks, having withdrawn glucose-lowering medications at baseline, followed by a structured ongoing support until 52 weeks, with regular follow-up with general practitioner, practice nurse, and/or dietitian. Data were collected at baseline, 12 weeks, and 52 weeks including QoL measures. Results: Of 39 participants recruited, 32 (82.1%) completed the 12-week TDR, and 27 (69.2%) provided 52-week data. Mean weight loss was 12.0 kg (95% CI: -9.6, -14.4, p<0.001) at 12 weeks and 9.1 kg (95% CI: -5.2, -12.9, p<0.001) at 52 weeks. HbA1c dropped by -1.1% (95% CI: -0.6 to -1.6, p<0.001) at 12 weeks and -0.6% (95% CI: -0.1 to -1.1, p=0.013) at 52 weeks. At the end of 12 and 52 weeks, 93.8% and 63.0% of participants remained off glucose-lowering medications, and 93.8% and 55.6% achieved diabetes remission, respectively. Sustained improvements in quality of life and wellbeing were observed at 12 and 52 weeks, as indicated by increases in EQ-5D Utility Index, EQ-5D VAS, and WHO-5 Well-being Index measures (p<0.001). Conclusions: These results support the feasibility of a structured diabetes remission intervention within the Australian context, and can inform the development of a framework for effective delivery of a structured diabetes remission service in Australian primary care