The metabolomic signature of weight loss and remission in the Diabetes Remission Clinical Trial (DiRECT) – published online 25/10/2023

Laura J. Corbin, David A. Hughes, Caroline J. Bull, Emma E. Vincent, Madeleine L. Smith, Alex McConnachie, Claudia‑Martina Messow, Paul Welsh, Roy Taylor, Michael E. J. Lean, Naveed Sattar, Nicholas J. Timpson

The Diabetes Remission Clinical Trial (DiRECT) demonstrated that a structured weight management programme, implemented in a primary care setting, can deliver both meaningful weight loss (24% of participants with more than 15kg weight loss) and type 2 diabetes remission (46% of participants at 12 months). In this issue, Corbin et al use (https://doi.org/10.1007/s00125-023-06019-x) high-throughput metabolomics technologies to explore the wider metabolic consequences of the same intervention. The authors investigated over 1000 metabolites in serum samples collected from 261 participants of the DiRECT trial before and 1 year after beginning the intervention (or control) treatment. Around 14% of all metabolites measured, including many associated with fat metabolism, were found to be altered in the intervention arm. The authors conclude that dietary weight loss reverses many important metabolomic changes previously associated with increased risk of type 2 diabetes, suggesting that excess weight is upstream of many of these metabolic aberrations.

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