A DiRECT approach to weight loss in a culturally diverse, low-income population: Pilot randomised controlled trial and meta-analysis of similar interventions

IF 5.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes, Obesity & Metabolism Pub Date : 2025-02-11 DOI:10.1111/dom.16240

Kate Campbell BSc, Natalie Ashton MDiet, Meredith C. Peddie PhD, Kim Ma'ia'i MD, Justine Camp PhD, Jim Mann DM, Andrew N. Reynolds PhD

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Abstract

Aims

To consider an intensive lifestyle intervention for weight loss in type 2 diabetes or prediabetes when delivered within a primary care service catering to indigenous (Māori), Pacific, refugee, and low-income clientele.

Materials and Methods

Adults with obesity, type 2 diabetes or prediabetes, and a desire to lose weight were randomised to dietitian-supported usual care or the Diabetes Remission Clinical Trial (DiRECT)-type intervention (3 months of total diet replacement followed by 9 months of food reintroduction and supported weight loss maintenance). Both interventions included equal dietetic support delivered within primary care. Primary outcome was weight loss at 3 and 12 months. We performed random-effects meta-analysis of body weight of existing DiRECT-type interventions.

Results

Forty participants were randomised to the dietitian-led DiRECT-type intervention or dietitian-supported usual care. At 3 months, weight loss among DiRECT-type intervention participants was −6.1 kg (95% CI −10.2, −2.0) greater than with dietetic support. At 12 months, this difference decreased to −3.8 kg (−7.6, −0.1) due to gradual weight loss with dietitian-supported usual care, not weight regain in DiRECT. Meta-analyses indicated −8.5 kg (−11.1, −5.9) and −6.0 kg (−8.4, −3.5) greater weight loss for DiRECT-type interventions than usual diabetes care (with or without dietary advice) at 3 and 12 months.

Conclusions

In this pilot effectiveness trial, the DiRECT-type intervention generated clinically relevant and greater weight loss than dietitian-supported usual care at 3 and 12 months. These results align with the effect sizes generated by meta-analyses of existing DiRECT-type interventions, demonstrating the potential use of DiRECT-type approaches across a much broader spectrum of the population than previously considered including those with both type 2 and prediabetes. ACTRN12622000151730.

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多元文化、低收入人群减肥的直接方法：类似干预措施的试点随机对照试验和荟萃分析。

目的：考虑在满足土著（Māori）、太平洋地区、难民和低收入客户的初级保健服务中对2型糖尿病或前驱糖尿病患者的体重减轻进行强化生活方式干预。材料和方法：肥胖、2型糖尿病或前驱糖尿病且有减肥愿望的成年人被随机分配到营养师支持的常规护理或糖尿病缓解临床试验（DiRECT）型干预组（3个月的完全饮食替代，随后9个月的食物重新引入和支持的减肥维持）。两种干预措施都包括在初级保健中提供同等的饮食支持。主要结局是3个月和12个月时体重减轻。我们对现有直接型干预措施的体重进行了随机效应荟萃分析。结果：40名参与者被随机分配到营养师主导的直接干预组或营养师支持的常规护理组。在3个月时，直接型干预参与者的体重减轻比饮食支持组多-6.1 kg （95% CI -10.2, -2.0）。在12个月时，由于在营养师支持的常规护理下体重逐渐减轻，而不是在DiRECT中体重反弹，这种差异减少到-3.8公斤（-7.6,-0.1）。荟萃分析显示，在3个月和12个月时，直接型干预比常规糖尿病护理（有或没有饮食建议）的体重减轻-8.5 kg（-11.1, -5.9）和-6.0 kg（-8.4, -3.5）。结论：在这项试点有效性试验中，直接型干预在3个月和12个月时比营养师支持的常规治疗产生了临床相关的体重减轻。这些结果与现有直接型干预措施的荟萃分析产生的效应大小一致，表明直接型方法的潜在应用范围比之前考虑的要广泛得多，包括2型糖尿病和前驱糖尿病患者。ACTRN12622000151730。

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来源期刊

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.