Brief formula low-energy-diet for relapse management during weight loss maintenance in the Diabetes Remission Clinical Trial (DiRECT).

Abstract

Weight loss maintenance (WLM) is critical for sustaining type 2 diabetes (T2D) remission, but poorly evidenced. We evaluated brief return to formula low-energy-diet (LED) as relapse treatments (RTs) during the WLM phase of the Diabetes Remission Clinical Trial (DiRECT). This post-hoc evaluation included all participants commencing the WLM phase of DiRECT. The protocol offered RT when regain of >2kg occurred. In total, 123/149 (83%) DiRECT intervention participants commenced the WLM phase after 26 (17%) had withdrawn prior to the WLM phase. Most participants [99/123 (80%)] regained >2kg during the WLM phase, among whom 60/99 (61%) were recorded as using RT and 39/99 (39%) not using any RT. At baseline, RT users had a higher mean (SD) body mass index [35.8 (4.9)kg m-2 vs. 33.8 (3.9)kg m-2 , p=0.0231] and had greater social deprivation (P=0.0003) than non-users, although otherwise the groups were similar. Weight loss≥2k g was achieved in 30/93 (32%) of RT attempts. At 2years, those regaining >2kg and using RT (n=60) had mean (SD) weight losses of 7.4 (6.1)kg, with 25 (42%) remissions and 7 (12%) programme withdrawals. Those regaining >2kg but not using RT (n=39) had weight losses of 8.8 (6.0)kg, with 21 (54%) remissions and 4 (10%) programme withdrawals (all not significant). Twelve participants were never recorded as having regained >2kg or using RTs and, at 2years, their weight losses were 12.9 (9.2)kg, with 4 (33%) remissions and 8 (67%) programme withdrawals. Most people with T2D experience weight regain >2kg during the 2years after substantial weight loss with a LED. Only one-third of RTs corrected their 2-kg regain, resulting in similar weight losses, remissions and programme withdrawals at 2years compared to those not using RTs; however, both groups had weight losses below those not recorded as regaining >2kg during WLM.