{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:48:49Z","timestamp":1789541329446,"version":"build-2803163510"},"reference-count":48,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>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 (M\u0101ori), Pacific, refugee, and low\u2010income clientele.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Adults with obesity, type 2 diabetes or prediabetes, and a desire to lose weight were randomised to dietitian\u2010supported usual care or the Diabetes Remission Clinical Trial (DiRECT)\u2010type intervention (3\u2009months of total diet replacement followed by 9\u2009months 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\u2009months. We performed random\u2010effects meta\u2010analysis of body weight of existing DiRECT\u2010type interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty participants were randomised to the dietitian\u2010led DiRECT\u2010type intervention or dietitian\u2010supported usual care. At 3\u2009months, weight loss among DiRECT\u2010type intervention participants was \u22126.1\u2009kg (95% CI \u221210.2, \u22122.0) greater than with dietetic support. At 12\u2009months, this difference decreased to \u22123.8\u2009kg (\u22127.6, \u22120.1) due to gradual weight loss with dietitian\u2010supported usual care, not weight regain in DiRECT. Meta\u2010analyses indicated \u22128.5\u2009kg (\u221211.1, \u22125.9) and \u22126.0\u2009kg (\u22128.4, \u22123.5) greater weight loss for DiRECT\u2010type interventions than usual diabetes care (with or without dietary advice) at 3 and 12\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this pilot effectiveness trial, the DiRECT\u2010type intervention generated clinically relevant and greater weight loss than dietitian\u2010supported usual care at 3 and 12\u2009months. These results align with the effect sizes generated by meta\u2010analyses of existing DiRECT\u2010type interventions, demonstrating the potential use of DiRECT\u2010type approaches across a much broader spectrum of the population than previously considered including those with both type 2 and prediabetes. ACTRN12622000151730.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.16240","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T01:16:03Z","timestamp":1739322963000},"page":"2442-2453","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A\n                    <scp>DiRECT<\/scp>\n                    approach to weight loss in a culturally diverse, low\u2010income population: Pilot randomised controlled trial and meta\u2010analysis of similar interventions"],"prefix":"10.1111","volume":"27","author":[{"given":"Kate","family":"Campbell","sequence":"first","affiliation":[{"name":"Department of Medicine University of Otago  Dunedin New Zealand"},{"name":"Department of Human Nutrition University of Otago  Dunedin New Zealand"},{"name":"Edgar Diabetes and Obesity Research Centre University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Ashton","sequence":"additional","affiliation":[{"name":"Te K\u0101ika Health, Medical Centre  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith C.","family":"Peddie","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Ma'ia'i","sequence":"additional","affiliation":[{"name":"Te K\u0101ika Health, Medical Centre  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justine","family":"Camp","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Otago  Dunedin New Zealand"},{"name":"Edgar Diabetes and Obesity Research Centre University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jim","family":"Mann","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Otago  Dunedin New Zealand"},{"name":"Edgar Diabetes and Obesity Research Centre University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8952-3892","authenticated-orcid":false,"given":"Andrew N.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Otago  Dunedin New Zealand"},{"name":"Edgar Diabetes and Obesity Research Centre University of Otago  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-023-05894-8"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci21-0034"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/oby.23725"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2024.100759"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.13172"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109119"},{"key":"e_1_2_10_8_1","volume-title":"HEARTS D: Diagnosis and Management of Type 2 Diabetes","author":"World Health Organization","year":"2020"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci22-0034"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci19-0014"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-021-05577-2"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0145721714534994"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc05-1942"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2012.03701.x"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)33102-1"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(20)30117-0"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2019-001012"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lansea.2022.100111"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14126"},{"key":"e_1_2_10_20_1","first-page":"5","volume-title":"IDF Atlas Reports: Diabetes among Indigenous Peoples","author":"Fischer\u2010Claussen C","year":"2022"},{"key":"e_1_2_10_21_1","volume-title":"IDF Diabetes Atlas","author":"International Diabetes Federation","year":"2021"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i5239"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_10_25_1","unstructured":"Type 2 diabetes management guidance.2023. 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