A5037322796- Diet and metabolism studies
- Bariatric Surgery and Outcomes
- Obesity and Health Practices
- Diabetes Treatment and Management
- Nutrition and Health in Aging
- Diabetes Management and Research
- Pharmacology and Obesity Treatment
- Health Systems, Economic Evaluations, Quality of Life
- Diabetes and associated disorders
- Diabetes, Cardiovascular Risks, and Lipoproteins
- Diabetes Management and Education
- Neurological and metabolic disorders
- Nutritional Studies and Diet
- Regulation of Appetite and Obesity
- Chronic Obstructive Pulmonary Disease (COPD) Research
- Asthma and respiratory diseases
- Clinical Nutrition and Gastroenterology
- Healthcare cost, quality, practices
- Health Promotion and Cardiovascular Prevention
- Medical Coding and Health Information
- Dysphagia Assessment and Management
- Child Nutrition and Feeding Issues
- Opioid Use Disorder Treatment
- Cannabis and Cannabinoid Research
- Obesity, Physical Activity, Diet
University of Glasgow
2014-2024
Unité de Nutrition Humaine
2013-2023
Glasgow Royal Infirmary
1997-2020
West Midlands Deanery
2014
University of Warwick
2014
University College London
2013
Royal United Hospital
2013
University of Bath
2013
Luton and Dunstable Hospital
2013
Robert Gordon University
2010
In DiRECT, a randomised controlled effectiveness trial, weight management intervention after 2 years resulted in mean loss of 7·6 kg, with 36% participants remission type diabetes. Of 36 the group who maintained over 10 kg at years, 29 (81%) were remission. Continued low-intensity dietary support was then offered up to 5 from baseline participants, aiming maintain and gain clinical benefits. This extension study designed provide observed outcomes years.
Background: Despite improving evidence-based practice following clinical guidelines to optimise drug therapy, Type 2 diabetes (T2DM) still exerts a devastating toll from vascular complications and premature death.Biochemical remission of T2DM has been demonstrated with weight loss around 15kg bariatric surgery in several small studies non-surgical energy-restriction treatments.The Counterweight-Plus programme, running Primary Care where obesity are routinely managed, produces >15 kg 33 % all...
Abstract Aim To identify predictors of type 2 diabetes remission in the intervention arm DiRECT (Diabetes Remission Clinical Trial). Methods Participants were aged 20–65 years, with duration <6 years and BMI 27–45 kg/m , not receiving insulin. Weight loss was initiated by total diet replacement (825–853 kcal/day, 3–5 months, shakes/soups), weight maintenance support provided for years. Remissions (HbA 1c <48 mmol/mol [<6.5%], without antidiabetes medications) group ( n = 149, mean...
There is no established primary care solution for the rapidly increasing numbers of severely obese people with body mass index (BMI) > 40 kg/m(2).This programme aimed to generate weight losses ≥15 kg at 12 months, within routine care.Feasibility study in care.Patients a BMI ≥40 kg/m(2) commenced micronutrient-replete 810-833 kcal/day low-energy liquid diet (LELD), delivered care, planned weeks or 20 loss (whichever was sooner), structured food reintroduction and then weight-loss maintenance,...
diabetes is key to improving outcomes and reducing healthcare costs, argue Louise McCombie colleagues
We aimed to assess whether a structured weight management programme incorporating total diet replacement (TDR) (3-5 months ∼850 kcal/day formula diet) loss phase is acceptable people of South Asian ethnicity and can achieve type 2 diabetes (T2D) remissions similarly other populations.
Substantial weight loss in type 2 diabetes can achieve a return to non-diabetic biochemical status, without the need for medication. The Diabetes Remission Clinical Trial (DiRECT), cluster-randomised controlled trial, is testing structured intervention designed and sustain this over years primary care setting determine practicability routine clinical practice. This paper reports characteristics of baseline cohort. People with <6 BMI 27–45 kg/m2 were recruited 49 UK practices, randomised...
Obesity is often associated with uncontrolled, difficult-to-treat asthma and increased morbidity mortality. Previous studies suggest that weight loss may improve outcomes, but heterogenous populations studied unclear consensus on the optimal method of management. The Counterweight-Plus Programme (CWP) for management an evidence-based, dietitian-led total diet replacement (TDR) program.
Abstract Background Weight management including formula total diet replacement (TDR) is emerging as an effective intervention for severe and complex obesity, particularly with respect to type 2 diabetes (T2 DM ). However, no prospective audit service evaluation of such programmes have been reported. Methods Following initial feasibility piloting, the Counterweight‐Plus programme was commissioned across a variety healthcare providers. The includes: Screening, TDR (formula low energy diet),...
Abstract Aims/hypothesis Approximately 10% of total healthcare budgets worldwide are spent on treating diabetes and its complications, increasing globally because ageing populations more expensive second-line medications. The aims the study were to estimate within-trial lifetime cost-effectiveness weight management programme, which achieved 46% remissions type 2 at year 1 36% in Diabetes Remission Clinical Trial (DiRECT). Methods Within-trial analysis assessed costs Counterweight-Plus...
Abstract Introduction The Diabetes REmission Clinical Trial (DiRECT) has shown that sustained remission of type 2 diabetes in primary care is achievable through weight loss using total diet replacement (TDR) with continued behavioural support. Understanding participants’ experiences can help optimise the intervention, support implementation into healthcare, and understand process behaviour change. Methods Thirty‐four DiRECT participants were recruited this embedded qualitative evaluation...
Our aim was to evaluate the safety and efficacy of a planned therapeutic withdrawal all antihypertensive diuretic medications, on commencing formula low-energy diet replacement, targeting remission type 2 diabetes.Post hoc analysis changes in BP, medication prescriptions symptoms during initial total replacement phase performed intervention arm Diabetes Remission Clinical Trial (n = 143) subset 69) who discontinued medications at start replacement. The Counterweight-Plus provided about 3470...
Abstract Patients with intellectual disability and neurological handicaps associated swallowing difficulties are vulnerable to dehydration undernutrition. Some patients severely undernourished, a condition which is usually recurrent food aspiration respiratory infections. Underweight provided adequate dietary protein by carers: their low energy intakes reflect inadequate of fat carbohydrate. Many gain weight following the provision easily assimilated energy‐dense fat‐ sugar‐containing foods....
As sustained weight loss is vital for achieving remission of type 2 diabetes, we explored whether randomisation to plus maintenance in the DiRECT trial was associated with physical activity, inactivity or sleep.Participants were randomised either a dietary management programme best-practice care. The group encouraged increase daily activity their sustainable maximum. Objective measurement achieved using wrist-worn GENEActiv accelerometer 7 days at baseline, 12 and 24 months both...
Abstract Background Community pharmacies may offer an accessible way of delivering weight-management programmes but there have been few trials that use clinically significant weight loss outcomes, objective measures and follow-up to 12 months. We aimed evaluate change among patients who used the Counterweight management programme delivered by community pharmacies. Methods The Programme was introduced into in Fife, Scotland 2009 for with a BMI ≥ 30 kg/m 2 or 28 co-morbidity localities which...
Abstract Aim The Counterweight‐Plus weight management programme achieved 46% remission of Type 2 diabetes at 1 year in the Di RECT trial. We estimated implementation costs and its 1‐year cost‐effectiveness terms remission, compared with usual care, from UK National Health Service ( NHS ) perspective. Methods Within‐trial total included set‐up running (practitioner appointment visits, low‐energy formula diet sachets training), oral anti‐diabetes anti‐hypertensive medications, healthcare...
Obesity-associated asthma results in increased morbidity and mortality. We report 1-year outcomes with a weight management regimen, the Counterweight-Plus Programme (CWP), compared usual care (UC) single-center, randomized controlled trial patients difficult-to-treat obesity.
Abstract Aim To investigate whether appetite‐related hormones were predictors of weight regain in the Diabetes Remission Clinical Trial (DiRECT). Materials and Methods DiRECT is a cluster‐randomized clinical trial, designed to assess effect loss on type 2 diabetes remission. For this post hoc analysis, data available for 253 (147 interventions, 106 controls) individuals with (age 53.6 ± 7.5 years, body mass index 34.7 4.4 kg/m , 59% men). Intervention participants received 24‐month...
The Diabetes Remission Clinical Trial (DiRECT) used a formula total diet replacement programme followed by structured weight loss maintenance to induce and sustain remission of type 2 diabetes (T2D) in 36% participants after years. Nurses dietitians delivering DiRECT 22 primary care practices Tyneside Scotland provided behavioural support participants. Participant experiences with highlighted the key role healthcare professionals (HCPs). We evaluated HCPs' DiRECT.Healthcare were interviewed...
A number of evidence-based weight management interventions are now available with different models and serving patient/client groups. While positive outcomes a key to the decision-making process, so too is information around how these were achieved, in what population, transferable would be population service aiming cover at cost provider or individual. This paper examines all UK recent peer-reviewed evidence their effectiveness 'realistic' settings cost-effectiveness, context National...