Research Success (DiRECT-Australia)

Diabetes Remission Program Shows Promising Results in Australian Primary Care

In a ground-breaking study, researchers at the School of Medicine, Macarthur Clinical School have successfully translated the Diabetes Remission Clinical Trial (DiRECT) intervention into multiple Australian primary care settings, offering hope for individuals with recent-onset type 2 diabetes to achieve remission through intensive weight loss using a structured program with total diet replacement. Led by Distinguished Prof David Simmons and A/Prof Milan Piya and executed by Dr Ritesh Chimoriya as part of his doctoral research, the evaluation of DiRECT-Australia has yielded promising results, demonstrating the effectiveness, acceptability and affordability of an intensive weight management program in improving health outcomes for individuals with type 2 diabetes.

"We've made significant progress in reshaping diabetes care through this project, and it should be adopted Australia-wide to offer anyone with recent type 2 diabetes the best possible chance to achieve diabetes remission. When someone has a heart attack, everything is done as soon as possible to prevent severe damage and early death. Type 2 diabetes is like a pancreas attack, and we now know that this intensive treatment can help to turn around the immediate harm being done"
– Distinguished Prof David Simmons

The DiRECT-Australia study was based on the DiRECT study conducted in the UK, which showed that an intensive weight management program in UK primary care led to high rates of diabetes remission among participants. Building on this success, the DiRECT-Australia program was implemented in the Macarthur region of South Western Sydney, Australia. The program involved total diet replacement with low-calorie meal replacements for 12 weeks, followed by a structured program for up to 52 weeks, including regular follow-up with general practitioners, dietitians, and practice nurses.

"Our study is making a big difference in how we tackle diabetes. We're finding better ways to help people with type 2 diabetes live healthier lives. These findings show it is feasible to embed the approach into routine clinical practice in all type of general practices-the big and the small, the urban and the rural"
- A/Prof Milan K. Piya

"As a doctoral candidate undertaking this project, I am confident that our research has the power to transform diabetes care in primary settings, offering tangible hope for those with recent-onset type 2 diabetes."
- Dr Ritesh Chimoriya

A recent paper published by the team in the reputed Journal of Diabetes Research (opens in a new window) showed promising results, with a significant decrease in average weight of 12 kg at 12 weeks and 9.1 kg at 52 weeks. The improvement in glycated haemoglobin (HbA1c) was also observed at both 12 (1.1%) and 52 weeks (0.6%). Impressively, the proportion of participants on diabetes medication at 52 weeks was statistically significantly lower compared to baseline, indicating the potential for long-term remission and health benefits. Furthermore, participants reported improved quality of life and wellbeing over the course of the program. Participants expressed a willingness to pay for the low-calorie meal replacement shakes, highlighting the perceived value of the program and the savings from less medications and food. The team also published a qualitative evaluation of the program in the reputed journal Diabetic Medicine, (opens in a new window) showing that both participants and healthcare professionals expressed strong interest in the new diabetes remission service in an Australian primary care setting. The participants highlighted its effectiveness in achieving substantial weight loss and diabetes remission, emphasising the necessity for its long-term and broader implementation to provide all individuals with recent-onset type 2 diabetes with the optimal opportunity for remission.

The research was also presented in Australasian Diabetes Congress 2023 by Dr Ritesh Chimoriya, which was well received and has been also cited in the reports submitted by Diabetes Australia to recent House of Representatives – parliamentary inquiry into diabetes. (opens in a new window)

Moving forward, the researchers hope that these findings will inform healthcare policies and practices, leading to wider adoption of similar programs across Australia. By investing in preventive measures and evidence-based interventions like the DiRECT-Australia program, we can strive towards a healthier future for all Australians affected by type 2 diabetes.

Research Team Members:

Dr Ritesh Chimoriya, Kimberly Mitlehner, A/Prof Freya MacMillan, A/Prof Chee L. Khoo, Dr Uchechukwu Levi Osuagwu, Dr Russell Thomson, A/Prof Lei Si, Prof Michael Lean, Distinguished Prof. David Simmons, A/Prof Milan K. Piya

Published papers:

• Translation of a Diabetes Remission Service into Australian Primary Care: Findings from the Evaluation of DiRECT-Australia (opens in a new window)
• A qualitative study of the perceptions and experiences of participants and healthcare professionals in the DiRECT-Australia type 2 diabetes remission service (opens in a new window)

This study was funded by a charitable donation to Western Sydney University and the Ingham Institute by Tony and Ron Perich, as well as the Lady (Mary) Fairfax Trust. Dr Ritesh Chimoriya is in receipt of a Western Sydney University Postgraduate Research Scholarship, funded by the Ainsworth Trust. Diabetes UK supported the work allowing the use of the name DiRECT-Australia.