Many thanks to Ellen Calteau Registered Dietician for this week’s note. Ellen is the Food Addiction Resources Operation Manager for the PHC charity. She spotted a pre-print paper announcing a protocol for a cluster randomised trial for the management of type 2 diabetes. The trial is called “Dietary Approaches to the Management Of type 2 Diabetes”, which has been called DIAMOND (Ref 1). The lead author was Jadine Scragg.
The background to the trial was given as there is “strong evidence” that type 2 diabetes (T2D) remission can be achieved with a low-energy (meal replacement) diet. There is “promising evidence” that low-carbohydrate diets can achieve remission of T2D. The DIAMOND trial aims to combine both approaches i.e., low-energy and low-carbohydrate. DIAMOND also plans to involve nurses in primary care to influence patient behaviour to achieve outcomes.
Two trials were used for references for the low-energy “strong evidence” – DiRECT and DIADEM-I (Ref 2). Average weight loss at 12 months in DiRECT and DIADEM-I were 10kg and 12kg in the intervention groups and 1kg and 4kg in the control groups respectively. DiRECT found that 46% of people randomised to the intervention went into remission at 1 year compared with 4% in the control group. At 2 years, the corresponding figures were 36% and 3%. The DiRECT trial found that weight loss was the only meaningful predictor of remission i.e., losing weight made achieving remission far more likely. In DIADEM-I, 61% of participants in the intervention group went into remission at 1 year, compared with 12% of the usual care group.