Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.
Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie Let al.
The Lancet · 2018; 391(10120):541-551
This study evaluates Primary care-led Counterweight-Plus programme: total diet replacement (825-853 kcal/day formula shakes/soups for 3-5 months), stepped food reintroduction (2-8 weeks), and structured long-term weight maintenance support with optional anti-obesity medication. in relation to Remission of type 2 diabetes (HbA1c <6.5% / <48 mmol/mol after ≥2 months off all antidiabetic drugs) and weight loss ≥15 kg at 12 months.
Evidence-Based Research: Direct Diabetes Remission Lancet
Key facts at a glance
- DOI
- 10.1016/s0140-6736(17)33102-1
- PMID
- 29221645
- Journal
- The Lancet
- Year
- 2018
- Volume
- 391
- Issue
- 10120
- Pages
- 541-551
- Study type
- guideline
- Evidence level
- Ib
- Sample size
- 306
- Intervention
- Primary care-led Counterweight-Plus programme: total diet replacement (825-853 kcal/day formula shakes/soups for 3-5 months), stepped food reintroduction (2-8 weeks), and structured long-term weight maintenance support with optional anti-obesity medication.
- Primary outcome
- Remission of type 2 diabetes (HbA1c <6.5% / <48 mmol/mol after ≥2 months off all antidiabetic drugs) and weight loss ≥15 kg at 12 months
- Follow-up
- 12 months
- Funding
- foundation
- Effect size
- Diabetes remission 46% vs 4% (OR 19.7, 95% CI 7.8-49.8); ≥15 kg weight loss 24% vs 0%
- Registration
- ISRCTN03267836
- Open access
- true
Study Overview
This study examined the effects of Primary care-led Counterweight-Plus programme: total diet replacement (825-853 kcal/day formula shakes/soups for 3-5 months), stepped food reintroduction (2-8 weeks), and structured long-term weight maintenance support with optional anti-obesity medication. on Remission of type 2 diabetes (HbA1c <6.5% / <48 mmol/mol after ≥2 months off all antidiabetic drugs) and weight loss ≥15 kg at 12 months.
Key Findings
The results suggest the intervention has potential clinical benefits.
Clinical Conclusions
See original publication.
Abstract
"This clinical guideline enrolled 306 participants, investigating the effects of Primary care-led Counterweight-Plus programme: total diet replacement (825-853 kcal/day formula shakes/soups for 3-5 months), stepped food reintroduction (2-8 weeks), and structured long-term weight maintenance support with optional anti-obesity medication. on Remission of type 2 diabetes (HbA1c <6.5% / <48 mmol/mol after ≥2 months off all antidiabetic drugs) and weight loss ≥15 kg at 12 months.
Funding & conflicts of interest
Funding: foundation
COI: Some authors received grants and personal fees from Counterweight Ltd and other weight-management companies; Diabetes UK funded the trial.
Related topics
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Medically reviewed by WellAlly Editorial Team Last reviewed July 22, 2026. · Read our editorial policy