PRIME CARDIAC NEWS

REMISSION OF DIABETES
MELLITUS - IS IT POSSIBLE?
PRIMARY CARE-LED WEIGHT MANAGEMENT
FOR REMISSION OF TYPE 2 DM
(DiRECT) Trial (Lancet 5 Dec, 2017)

Ÿ Introduction: Type 2 DM is a life long

disease requiring treatment. In a UK
study, nearly 300 patients have been
randomized to intensive weight
management Vs standard treatment
with drugs.

Ÿ What did they do?

Patients were not on insulin but on oral

drugs (DM for > 6 y) with BMI between
29-45 kg/m2. The intervention
comprised withdrawal of anti-diabetic
and antihypertensive drugs, total diet
replacement (825–853 kcal/day
formula diet for 3–5 months), stepped
food reintroduction (2–8 weeks), and
structured support for long-term
weight loss maintenance.
Ÿ What were the results?
25% of dietary restriction group achieved
a weight loss of 15 kg or more and none
on control group. Diabetes remission
was achieved in 50% of the weight loss
group. This remission persisted in
nearly 85% at the end of one year who
continued to maintain the weight loss
between 10-15 kg. At 12 months,
almost half of participants achieved
remission to a non-diabetic state and
off anti-diabetic drugs.
Ÿ Comment: These results are impressive
and strongly support the view that type
2 DM is tightly associated with
excessive fat mass in the body. Weight
loss should be the primary goal in the
treatment of type 2 diabetes. Weight
loss results in improved insulin
sensitivity in muscles and liver,
decreases intra-organ fat content, and
might improve insulin secretion. In the
long term, weight loss might help to
preserve β-cell mass. The DiRECT study
indicates that the time of diabetes
diagnosis is the best point to start
weight reduction and lifestyle changes
because motivation of a patient is
usually high and can be enhanced by
the professional health-care providers.
Dr. C. Raghu
MD, DM, FESC, FACC, FSCAI, FAPSIC
Interventional Cardiologist - Director
For support on
any cardiac case management
e-mail to raghu@drraghu.com
M: +91 98481 55650

040 4959 4959 WWW.ASTERPRIME.COM