TDMR Europe supports World Diabetes Day

Posted On: 13th November 2019

TDMR Europe welcomes the opportunity to support this year’s theme ‘Family and Diabetes’ on World Diabetes Day.  People world-wide are encouraged to test their diabetes knowledge with an on-line tool for self-assessment of diabetes risk noting that over 50% of diabetes is preventable.  If left untreated diabetes can lead to complications including heart attack and stroke.

Weight management including weight reduction is a key component of diabetes prevention programmes and most prevention trials have shown that greater weight losses lead to more effective prevention. Greater weight losses can be achieved using LED (low energy diets) sometimes using formula diet products as a total diet replacement (TDR).   Increasing physical activity and improving diet quality are also important changes to make to prevent diabetes.  A large study designed to test the effect of TDR followed by 3 years of diet maintenance with increased physical activity has taken place in six European countries as well as in Australia and New Zealand (PREVIEW).

After extensive screening 2224 people with pre-diabetes began an 800kcal/d formula low energy diet (a TDR) which they followed for eight weeks. 91% of participants successfully completed the diet programme losing 10.7kg on average over 8 weeks (average weight loss in men was 11.8kg and in women was 10.2kg).  83.5% (1857 participants) achieved 8% or more weight loss enabling them to enter the three-year maintenance programme in which high exercise levels were compared with moderate exercise, and high-protein low-glycaemic index diets were compared with moderate-protein moderate-glycaemic index diets.  Publication of the 3 year results is still awaited but it is understood that there were no differences between the dietary groups in terms of weight maintenance at three years, though the number of participants who developed diabetes by three years was low compared to other diabetes prevention trials.  The fully published results of the TDR weight-loss phase (Christensen P, etal, 2018) showed that TDR is a safe effective method of achieving a good weight loss of more than 8% as the first phase of a diabetes prevention programme.

The larger weight losses achievable with TDR have been used as the first phase of a major diabetes remission trial (the DiRECT trial) undertaken in Glasgow in Scotland and Newcastle in England.  This cluster randomised controlled trial in overweight and obese people with type 2 diabetes of no more than 6 years duration was based in primary care practices. One year after commencing the intervention, that included a strong behavioural and educational programme led by dietitians and practice nurses, as well as an initial weight loss with TDR, 3 out of every 4 participants who maintained 10kg weight loss at one year were in diabetes remission (Lean M et al 2018).  The programme continued for a second year at the end of which nearly 60% of those who maintained 10kg weight loss were still in remission (Lean M et al 2019).

Professor Anthony Leeds, chairman of TDMR Europe said ‘the evidence base for the use of TDR in diabetes and related co-morbidities grows steadily as more high-quality studies, are published. The three-year PREVIEW results are eagerly awaited as are results of a trial of TDR in people with insulin-treated type 2 diabetes.’

Professor Mike Lean describes the DiRECT trial in an interview at: