Intensive Lifestyle Intervention for Remission of Early Type 2 Diabetes in Primary Care in Australia: DiRECT-Aus
Open accessAbstract
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 primary care setting. RESEARCH DESIGN AND METHODS: Individuals aged 20–65 years with T2D duration up to 6 years, BMI >27.0 kg/m2, and not treated with insulin were prescribed a 13-week low-energy TDR (Optifast; Nestlé Health Science) followed by 8-week structured food reintroduction and 31-week supported weight maintenance. The primary outcome was T2D remission at 12 months. RESULTS: A total of 155 participants comprised the intention-to-treat population. At 12 months, T2D remission was achieved in 86 (56%) participants, with a mean adjusted weight loss of 8.1% (95% CI 7.2–9.1). Two serious adverse events requiring hospitalization related to the study intervention were reported. CONCLUSIONS: At 12 months T2D remission was achieved for one in two Australian adults in a primary care setting.
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The UK DiRECT study and the DiRECT-Aus trial provide evidence that remission is possible with sustained weight loss maintenance, with 68 out of 138 people and 86 out of 155 people in the intervention group achieving remission at 12 months in each respective cohort.
“The UK DiRECT study, as well as the DiRECT-Aus trial provide evidence that remission is possible with sustained weight loss maintenance, with 68 out of 138 people, and 86 out of 155 people in the intervention group achieving remission at 12 months in each respective cohort31,37.”
From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [37]
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Lean, M. E., Leslie, W. S., Barnes, A. C., Brosnahan, N., Thom, G., McCombie, L., Peters, C., Zhyzhneuskaya, S., Al-Mrabeh, A., Hollingsworth, K. G., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(17)33102-1 · Cited by 2,095 · see citing works
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Scragg, J., Koutoukidis, D. A., Dirksen, C., Heitmann, B. L., & Jebb, S. A. (2025) · Med · doi:10.1016/j.medj.2025.100805 · Cited by 16 · see citing works
Kolivas, D., Fraser, L., Schweitzer, R., Brukner, P., & Moschonis, G. (2025) · npj Metabolic Health and Disease · doi:10.1038/s44324-025-00053-6 · Cited by 7 · see citing works
- Authors
- Hocking, S. L., Markovic, T. P., Lee, C. M. Y., Picone, T. J., Gudorf, K. E., & Colagiuri, S.
- Affiliations
- The University of Sydney (AU)
- Curtin University (AU)
- Diabetes Australia (AU)
- Corresponding author
- Hocking, Samantha L.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2023-10-16
- Volume
- 47
- Issue
- 1
- Pages
- 66-70
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC10733653
- OpenAlex
- W4387661608
- Cited by
- 40
- References
- 1
- Citations by year
- 2026: 8 · 2025: 23 · 2024: 8 · 2023: 1
- FWCI
- 8.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion)
- Funders
- South Western Sydney Primary Health Network
- Healthy North Coast
- Diabetes Australia
- Western Sydney Primary Health Network
- Western NSW Primary Health Network
- Nestle Health Science
- Sydney North Health Network
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes remission, total diet replacement, hypocaloric diet, lifestyle intervention, weight loss, food reintroduction, weight maintenance, primary care, early type 2 diabetes, obesity
- MeSH terms
- Adult, Australia, Diabetes Mellitus, Type 2, Humans, Life Style, Primary Health Care, Weight Loss
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