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1/9 Shakes
and soups 
prescribed on the NHS to reverse diabetes 
From 1 Sept, 5,000 people with #T2DM in 10 areas of
are going to be offered them
What's all the fuss about?
Do they work? Are they the best option available?
A short Twitter thread.... #MedTwitter
and soups prescribed on the NHS to reverse diabetes From 1 Sept, 5,000 people with #T2DM in 10 areas of
are going to be offered themWhat's all the fuss about?
Do they work? Are they the best option available?A short Twitter thread.... #MedTwitter
2/9 The evidence to support this comes from the work of Prof Roy Taylor's DiRECT Trial, published in @TheLancet (refs at end)
306 ppl age 20-65 with #T2DM diagnosed in last 6 yrs, were randomly allocated to either:
Diet OR
"Current best practice"
Ppl on insulin were excluded
306 ppl age 20-65 with #T2DM diagnosed in last 6 yrs, were randomly allocated to either:
Diet OR
"Current best practice"
Ppl on insulin were excluded
3/9 The DiRECT Trial
1. Removal of meds for #T2DM + BP on day 1
2. TOTAL diet replacement with a 825-853 cal/day liquid formula (soup or shake) for 3-5 months, then:
3. Stepped food reintroduction for 2-8 weeks, then:
4. Structured support for long-term weight loss maintenance
1. Removal of meds for #T2DM + BP on day 1
2. TOTAL diet replacement with a 825-853 cal/day liquid formula (soup or shake) for 3-5 months, then:
3. Stepped food reintroduction for 2-8 weeks, then:
4. Structured support for long-term weight loss maintenance
4/9 The DiRECT diet is a VERY LOW CALORIE diet
Interestingly (this is important) it contains between 122-126g of carbohydrate/day which ALSO makes it a LOW CARBOHYDRATE DIET #LCHF (but NOT a VERY low carb diet)
Participants were given 4 x 200cal sachets of soup or shake a day
Interestingly (this is important) it contains between 122-126g of carbohydrate/day which ALSO makes it a LOW CARBOHYDRATE DIET #LCHF (but NOT a VERY low carb diet)
Participants were given 4 x 200cal sachets of soup or shake a day
5/9 DiRECT Trial Results:
At 1 year in the diet group, 46% achieved remission and 24% lost >15kg [4% and 0% of controls respectively]
At 2 years remission had
to 36% on diet and 3% of controls (see table - thanks @zoeharcombe )
Remission was closely related to weight loss
![5/9 DiRECT Trial Results:At 1 year in the diet group, 46% achieved remission and 24% lost >15kg [4% and 0% of controls respectively]At 2 years remission had to 36% on diet and 3% of controls (see table - thanks @zoeharcombe )Remission was closely related to weight loss](https://pbs.twimg.com/media/EhUUaRVXcAA0iyC.png "5/9 DiRECT Trial Results:At 1 year in the diet group, 46% achieved remission and 24% lost >15kg [4% and 0% of controls respectively]At 2 years remission had to 36% on diet and 3% of controls (see table - thanks @zoeharcombe )Remission was closely related to weight loss")
At 1 year in the diet group, 46% achieved remission and 24% lost >15kg [4% and 0% of controls respectively]
At 2 years remission had
to 36% on diet and 3% of controls (see table - thanks @zoeharcombe )Remission was closely related to weight loss
6/9 Costs:
A review (see link) calculated the cost as £1,907 per remission achieved
When you consider that diabetes costs the NHS and estimated £10bn/year this seems good value
https://link.springer.com/content/pdf/10.1007/s00125-020-05224-2.pdf
A review (see link) calculated the cost as £1,907 per remission achieved
When you consider that diabetes costs the NHS and estimated £10bn/year this seems good value
https://link.springer.com/content/pdf/10.1007/s00125-020-05224-2.pdf
7/9 Low Calorie v Low Carb
Disappointingly, DiRECT doesn't look at this. From the research with @lowcarbGP at my practice we have found that #LCHF diets achieve a remission rate in #T2DM of 49% and that #LCHF diets are sustainable over many years
Disappointingly, DiRECT doesn't look at this. From the research with @lowcarbGP at my practice we have found that #LCHF diets achieve a remission rate in #T2DM of 49% and that #LCHF diets are sustainable over many years
8/9 My reflections
Great to be using dietary interventions in #T2DM rather than meds
I'm not convinced v low calorie diets are sustainable long term, #LCHF is
These soups + shakes are ULTRA-PROCESSED foods
Aren't we meant to avoid them?
Where's the real food?
Great to be using dietary interventions in #T2DM rather than meds
I'm not convinced v low calorie diets are sustainable long term, #LCHF is
These soups + shakes are ULTRA-PROCESSED foods
Aren't we meant to avoid them?
Where's the real food?
9/9 References:
A huge thank you to @zoeharcombe (see also https://www.zoeharcombe.com ) for her help and hard work making sense of it all.
https://www.england.nhs.uk/2020/09/thousands-to-benefit-from-soups-and-shakes-diet-on-the-nhs-from-today/
https://www.directclinicaltrial.org.uk/
https://www.mdpi.com/1660-4601/16/15/2680
https://link.springer.com/content/pdf/10.1007/s00125-020-05224-2.pdf
A huge thank you to @zoeharcombe (see also https://www.zoeharcombe.com ) for her help and hard work making sense of it all.
https://www.england.nhs.uk/2020/09/thousands-to-benefit-from-soups-and-shakes-diet-on-the-nhs-from-today/
https://www.directclinicaltrial.org.uk/
https://www.mdpi.com/1660-4601/16/15/2680
https://link.springer.com/content/pdf/10.1007/s00125-020-05224-2.pdf
