Randomised controlled trialindependent cross-checkabstract checked★ key study I-DIAB-101 in-depth review
Weight-loss programme puts early type 2 diabetes into remission in Qatar
Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial.
Overview
Taheri S et al.. Lancet Diabetes Endocrinol 2020 · PMID 32445735 · DOI 10.1016/S2213-8587(20)30117-0
61% of young adults with recent type 2 diabetes reached remission after an intensive diet programme, versus 12% with usual care.
Does the study support the specific claim? Partly · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Test intensive lifestyle therapy for early T2D in the MENA region.
- How was the study done?
Randomised trial.
- How many people, animals or samples were studied?
158 adults, diabetes <=3 years.
- What was actually found?
Weight -12 kg; remission 61% vs 12%.
- How large was the observed effect?
Difference 49 points; NNT about 2.
- What do the results mean in everyday life?
Early type 2 diabetes can go into remission with major weight loss under supervision.
- What are the study's limitations?
12 months; open label; no insulin users.
- What does it say about Elawady's specific claim?
Supports the kernel for early T2D only.
- Do the results apply to Germany and Europe?
Matches UK DiRECT.
- What can explicitly not be concluded from this study?
Cannot support stopping insulin or curing T1D.
Scientific in-depth review
1. Full reference
- Authors
- Taheri S et al.
- Journal
- Lancet Diabetes Endocrinol
- Year
- 2020
- Identifier
- PMID 32445735 DOI 10.1016/S2213-8587(20)30117-0
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Qatar National Research Fund (record).
2. Research question
Does an intensive lifestyle intervention with total diet replacement produce weight loss and remission in young people with early T2D from the Middle East and North Africa?
3. Study design and population
- Study design
- Randomised controlled trial – Open-label parallel-group RCT in primary care and community settings
- Population
Adults 18-50 with T2D <=3 years, BMI >=27, from the MENA region
- Country
Qatar
- Period
2017-2018 enrolment; 12 months
- Sample size
158 randomised; 147 analysed (70 vs 77)
- Inclusion and exclusion criteria
Age 18-50, duration <=3 years, BMI >=27, MENA origin
4. Methods and endpoints
- Exposure / intervention
Total diet replacement (low-energy formula), food reintroduction, physical activity, maintenance support
- Comparator
Usual guideline-based care
- Endpoints
Weight loss at 12 months; remission; normoglycaemia
- Statistical methods
ITT; adjusted mean difference; ORs
5. Actual results
- Results
Weight -11.98 kg (9.72-14.23) vs -3.98 kg (2.78-5.18); adjusted difference -6.08 kg (-8.37 to -3.79). Remission 61% vs 12%, OR 12.03 (5.17-28.03); normoglycaemia 33% vs 4%, OR 12.07 (3.43-42.45). >15% weight loss 21% vs 1%.
- Absolute risks
Remission 61% vs 12% (difference 49 points; NNT about 2; stats/C-DIAB-03_remission.py)
- Authors' conclusion
Intensive lifestyle intervention led to significant weight loss and was associated with remission in over 60%.
6. Strengths
- Randomised
- Arab-region population
- Registered
7. Weaknesses
- Open label
- 12-month follow-up
- Young, early T2D only; no insulin users
8. Risk of bias
- Orienting tool
- RoB 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Open-label; objective outcomes.
9. Assessment of the statistical interpretation
Large effect; ORs exaggerate relative effect because outcome is common (RR = 61/12 = 5.1).
10. Relevance to the specific claim
Correct kernel of the claim: in early type 2 diabetes, substantial weight loss through a structured diet can induce remission, including in Arab populations. It required meal replacement and support, not a particular food list, and excluded long-standing or insulin-treated diabetes.
11. Independent contrary findings
12. Transferability to Germany and Europe
Replicates DiRECT (UK); applicable to Europe and the MENA region.
13. Overall methodological judgement
High-quality, regionally relevant support for remission in early T2D.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |