DiRECT NEWS

2024 Rank Prize for Nutrition awarded to the DiRECT leaders

The Rank Prize for Nutrition, usually awarded every two years, is reckoned the world’s most prestigious prize for research in nutritional sciences. The 2024 prize was awarded to the leaders of the DiRECT trial, Professors Mike Lean and Roy Taylor, at a ceremony in the Royal College of Physicians of London, on July 1st 2024.

The award was made for their independent research paths, investigating the reasons for type 2 diabetes developing and the possibility of reversing the process, which came together with the DiRECT Trial.

https://www.rankprize.org/prize/nutrition/winners/2024/

https://www.rankprize.org/news-events/rank-prizes-2024-awarded-in-london/

THE RANK PRIZE FOR NUTRITION 2024

For Professor Roy Taylor and Professor Mike Lean for their work on use of low energy diets to understand the pathogenesis of type 2 diabetes and subsequent trials that have led to possibility of disease remission.

Roy Taylor BSc, MB ChB, MD, FRCP, FRCPE

Professor of Medicine and Metabolism, University of Newcastle

Honorary Consultant Physician, Newcastle Acute Hospitals NHS Trust

Mike Lean MA, MB BChir, MD (Cambridge), FRCP (Edinb), FRCPS (Glasgow), FRSE

Professor of Human Nutrition, University of Glasgow

Honorary Consultant Physician, Glasgow Royal Infirmary.

Type 2 diabetes is a disabling, life-shortening, disease, mediated by excess or abnormal body fat accumulation. Work by Professor Mike Lean in the 1990s, when he held the Rank Chair of Human Nutrition in Glasgow, showed that a high waist circumference, as a measure of central adiposity, even in people with a healthy body mass index, was associated with an increased risk of type 2 diabetes. In other research he showed that weight loss early after diagnosis of type 2 diabetes was associated with improved prognosis: those who lost 15kg had similar life expectancy as people without diabetes. Professor Roy Taylor’s research on liver and muscle led to the 2008 twin cycle hypothesis, that type 2 diabetes is caused by excess fat in the liver leading to insulin resistance and in the pancreas leading to beta-cell dysfunction. He tested the hypothesis in the Counterpoint study of 2011 that managed people with recent onset of type 2 diabetes with a liquid ‘meal replacement’ diet of 800kcal/day for 8 weeks, whilst studying their metabolism and deposition of fat in different organs using magnetic resonance imaging. People lost weight (about 15kg) and this decreased liver fat and liver insulin resistance and decreased pancreas fat with increased insulin secretion and lowered blood glucose. Hence the changes of type 2 diabetes could be reversed early in the course of diabetes, by weight loss. The follow-up Counterbalance study included people with longstanding diabetes, and showed that, although still effective at improving insulin resistance and beta cell function, the intervention was less effective at producing remission once diabetes had been established for more than 6 years, showing that early intervention is best.

Collaborative work with Mike Lean led to the design and conduct of the DIabetes REmissions Clinical Trial (DiRECT). This was funded by Diabetes UK, to translate their earlier research findings into a practical and importantly, scalable, intervention, using liquid meal replacements for 8-12 weeks, followed by gradual introduction of normal food, delivered in primary care. This led to maintained weight loss of over 10kg on average, and remission of diabetes in almost half of the participants after one year. Over three quarters of these were still in remission after 2 years. Over 80% of those who lost 15kg or more were in remission for 2 years. Subsequent research has shown that the intervention is also successful in people with relatively low body weight, not only those living with visible obesity, and leading to the concept of a ‘personal fat threshold’ for risk of diabetes.

The ‘DiRECT Principles’ intervention is now being rolled out across NHS Scotland and in NHS England as the Type 2 Diabetes Path to Remission programme, and over 5000 individuals have now had the opportunity to be offered the intervention, with early results being consistent with what was seen in the DiRECT trial. The work is recognised internationally, with the results being reproduced in trials conducted in (for example) the Middle East, Australia, New Zealand, Malaysia, Nepal and Barbados. The approach is now included as a treatment option in the Joint American Diabetes Association and European Association for the Study of Diabetes Standards of Care document, and famously it has been popularised in an accessible form by Michael Mosley.

This research is making a real difference to the lives of many people with type 2 diabetes, and the researchers are worthy recipients of the Rank Prize for Nutrition.

Date published - 1 July 2024

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