{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:51:57Z","timestamp":1791316317377,"version":"4.3.1"},"reference-count":31,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Diabetes"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The Diabetes Remission Clinical Trial (DiRECT) demonstrated that remission of type 2 diabetes can be achieved through substantial weight loss using a total diet replacement (TDR) intervention combined with structured support. Whether this approach can be delivered exclusively via eHealth has not been well studied.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This pilot study aimed to evaluate whether a TDR intervention delivered solely via eHealth could induce clinically meaningful weight loss and achieve type 2 diabetes remission.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This was a single-arm, nonblinded, single-center pilot study conducted at the clinical research facilities of Ume\u00e5 University Hospital. Individuals with type 2 diabetes diagnosed within the past 6 years were included. Participants followed a TDR (~850 kcal\/d) for 12 weeks, and then gradually reintroduced food, with a total study duration of 6 months. Diabetes medications were discontinued at the start of the study. Daily body weight and fasting glucose were measured at home and transmitted to the study team via connected devices. All clinical support was delivered through video calls and chat. The 2 prespecified coprimary outcomes were a reduction in weight of 15 kg or more and remission of diabetes, defined as glycated hemoglobin\n \n below 6.5% without glucose-lowering medication, from baseline to 6 months. A 75 g oral glucose tolerance test and indirect calorimetry were performed at baseline and at 6 months to assess resting energy expenditure (REE) and respiratory quotient (RQ).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Ten participants (mean age 58.5, SD 7.4 y; mean BMI 35.3, SD 5.9 kg\/m\u00b2; n=9 men and n=1 woman) were enrolled. After 6 months, 6 of 10 participants achieved the prespecified coprimary outcome of \u226515 kg weight loss, and all 10 participants achieved the prespecified coprimary outcome of diabetes remission. Mean weight loss was 16.9 (SD 5.4;\n P<\/jats:italic>\n =.005) kg, and\n \n glycated hemoglobin\n \n decreased by 1.0% (SD 0.8%\n ; P<\/jats:italic>\n =.008). Daily home measurements showed a marked reduction in fasting glucose within the first week of the intervention. Median REE decreased by 19% (IQR 17%-22%), while median fasting RQ increased by 15% (IQR 5%-27%) and median post\u2013glucose-load RQ increased by 12% (IQR 9%-18%) at 6 months.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this pilot study, an eHealth-delivered TDR intervention was associated with substantial weight loss and diabetes remission at 6 months without the use of glucose-lowering medication. These findings support further evaluation of fully eHealth-delivered dietary interventions in larger and longer-term randomized controlled trials.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/93074","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:13:30Z","timestamp":1791314010000},"page":"e93074-e93074","source":"Crossref","is-referenced-by-count":0,"title":["An eHealth-Delivered Total Diet Replacement Intervention for Type 2 Diabetes Remission: Single-Arm Pilot Study"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4694-8166","authenticated-orcid":false,"given":"Youssef","family":"Chninou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9231-7931","authenticated-orcid":false,"given":"Johannes","family":"Edholm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Engvall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2926-6449","authenticated-orcid":false,"given":"Sofia","family":"Wahlqvist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3539-7130","authenticated-orcid":false,"given":"Claudia","family":"Schien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9122-7240","authenticated-orcid":false,"given":"Anna","family":"Winkvist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9016-1139","authenticated-orcid":false,"given":"Julia","family":"Otten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107843","article-title":"Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition","volume":"157","author":"Saeedi","journal-title":"Diabetes Res Clin Pract"},{"issue":"6","key":"R2","doi-asserted-by":"publisher","first-page":"1562","DOI":"10.2337\/dc06-2544","article-title":"Effect of BMI on lifetime risk for diabetes in the U.S","volume":"30","author":"Narayan","journal-title":"Diabetes Care"},{"issue":"2","key":"R3","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1038\/nrendo.2017.151","article-title":"Global aetiology and epidemiology of type 2 diabetes mellitus and its complications","volume":"14","author":"Zheng","journal-title":"Nat Rev Endocrinol"},{"issue":"10","key":"R4","doi-asserted-by":"publisher","first-page":"2438","DOI":"10.2337\/dci21-0034","article-title":"Consensus report: definition and interpretation of remission in type 2 diabetes","volume":"44","author":"Riddle","journal-title":"Diabetes Care"},{"issue":"5","key":"R5","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/S2213-8587(19)30068-3","article-title":"Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial","volume":"7","author":"Lean","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"6","key":"R6","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1016\/S2213-8587(20)30117-0","article-title":"Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial","volume":"8","author":"Taheri","journal-title":"Lancet Diabetes Endocrinol"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-016-0406-2","article-title":"The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial","volume":"17","author":"Leslie","journal-title":"BMC Fam Pract"},{"key":"R8","unstructured":"Global strategy on digital health 2020-2025. 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