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RESEARCH ARTICLE (Open Access)
Contents Vol 31(2)

Maximising the potential of type 2 diabetes remission: scale up and sustainability considerations from the DiRECT-Aus implementation trial

Nilakshi Gunatillaka https://orcid.org/0009-0006-0826-9719 A , Jenny Advocat A , Lauren Ball https://orcid.org/0000-0002-5394-0931 B , Terry Haines A , Cylie Williams A , Tze Lin Chai A , Mitchell Bowden C , Melissa Savaglio C , Kate Gudorf D E Elizabeth Sturgiss A *
+ Author Affiliations
- Author Affiliations

A School of Primary and Allied Health Care, Monash University, Melbourne, Vic 3199, Australia.

B Centre for Community Health and Wellbeing, The University of Queensland, Brisbane, Qld 4072, Australia.

C Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic 3141, Australia.

D Diabetes Australia, Sydney, NSW 2037, Australia.

E Western Sydney Primary Health Network, Sydney, NSW 2560, Australia.

* Correspondence to: esturgiss@bond.edu.au

Australian Journal of Primary Health 31, PY24116 https://doi.org/10.1071/PY24116
Submitted: 29 July 2024  Accepted: 17 February 2025  Published: 3 March 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Approximately 500 million people worldwide live with type 2 diabetes mellitus. The UK’s ‘Diabetes Remission Clinical Trial’ (DiRECT) is a potential novel method for care. An Australian trial of DiRECT (DiRECT-Aus) showed that 56% of participants achieved diabetes remission at 12 months. We explored the experiences of patients, clinicians and trial partners involved in DiRECT-Aus to ascertain the acceptability and feasibility of DiRECT-Aus, as well as factors influencing implementation, to inform recommendations for sustainable scale up into mainstream primary care.

Methods

This qualitative implementation research conducted within a constructivist paradigm involved semi-structured interviews with key stakeholders. Data analysis followed an inductive thematic approach, informed by the Consolidated Framework for Implementation Research.

Results

Patients (n = 14), general practitioners (n = 3), practice nurses (n = 6), dietitians (n = 7) and DiRECT-Aus trial partners (n = 5) were interviewed. We identified four core components of DiRECT-Aus that are essential for implementation and scale up. They were: (1) access to very low-energy diet products; (2) high frequency of contact with the dietitian; (3) dietitian’s clinical knowledge and patient-centred practice; and (4) absence of financial costs to patients. Several additional factors that could support implementation and suggested funding models are described.

Conclusions

This study concludes that DiRECT-Aus was acceptable and feasible to patients and clinicians.

Keywords: chronic disease, general practice, implementation research, medical nutrition therapy, primary care, qualitative, type 2 diabetes, very low energy diet.

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