Toronto 3D (Diet, Digestive Tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada.
School of Medicine, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Front Endocrinol (Lausanne). 2022 Jun 2;13:888557. doi: 10.3389/fendo.2022.888557. eCollection 2022.
The prognosis for people with type 2 diabetes (T2D) remains concerning, yet its seriousness is often underestimated. T2D is a manifestation, in susceptible individuals, of the disease-process of obesity, and at diagnosis, 10-year survival rates for T2D are around 50%. Here, we will examine: (a) the role of weight loss in T2D, (b) use of total diet replacements (TDRs) to induce weight loss, (c) the Diabetes Remission Clinical Trial (DiRECT) protocol and key results, (d) other dietary interventions related to T2D remission, (e) remission in real life, and (f) future directions. Remission of short-duration T2D will usually require 10-15% body weight loss, and results from the DiRECT trial demonstrated that this can be achieved within routine care in nearly half of all people undertaking a supported, TDR-led behavioural weight management programme. In light of these findings, which have since been replicated in the Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I) trial conducted in the Middle East and North Africa, it is now time to prioritize weight loss programmes for T2D remission from diagnosis, and with increasing acceptance and availability of digital healthcare, there is an opportunity to scale up delivery of remission programmes in a cost effective manner.
2 型糖尿病（T2D）患者的预后仍然令人担忧，但人们往往低估了其严重性。T2D 是肥胖疾病过程在易感个体中的表现，在诊断时，T2D 的 10 年生存率约为 50%。在这里，我们将探讨：（a）体重减轻在 T2D 中的作用，（b）使用全饮食替代物（TDR）诱导体重减轻，（c）糖尿病缓解临床试验（DiRECT）方案和关键结果，（d）与 T2D 缓解相关的其他饮食干预措施，（e）现实生活中的缓解情况，以及（f）未来方向。短期 T2D 的缓解通常需要减轻 10-15%的体重，DiRECT 试验的结果表明，在接受支持性、以 TDR 为导向的行为体重管理计划的几乎一半人中，常规护理可以实现这一目标。鉴于这些发现，随后在中东和北非进行的糖尿病干预强调饮食和增强代谢（DIADEM-I）试验中得到了复制，现在是时候从诊断开始优先考虑 T2D 缓解的体重减轻计划了，随着对数字医疗保健的接受度和可用性的提高，有机会以具有成本效益的方式扩大缓解计划的实施。
