Evidence mapPaperPMID 41904649Full record

Trial reportDiabetic medicine : a journal of the British Diabetic Association2026

Cost-effectiveness of the diabetes remission clinical trial (DiRECT)/Counterweight-Plus weight management programme, based on 5-year follow-up.

A Davies, E Grieve, L McCombie, A McIntosh, A McConnachie, W S Leslie, N Sattar, R Taylor, M E J Lean

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in Diabetic medicine : a journal of the British Diabetic Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

A DaviesHealth Economics and Health Technology Assessment, School of Health and Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
E GrieveHealth Economics and Health Technology Assessment, School of Health and Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.ORCID https://orcid.org/0000-0002-4115-2882
L McCombieHuman Nutrition, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
A McIntoshRobertson Centre for Biostatistics, School of Health and Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
A McConnachieRobertson Centre for Biostatistics, School of Health and Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
W S LeslieHuman Nutrition, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
N SattarSchool of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.ORCID https://orcid.org/0000-0002-1604-2593
R TaylorNewcastle Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
M E J LeanHuman Nutrition, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.ORCID https://orcid.org/0000-0003-2216-0083

Funding

Diabetes UK
6 · The paper itself

Abstract

aimsFollow-up of the Counterweight-Plus intervention in DiRECT has demonstrated 6.1 kg weight loss and 10 % remissions from type 2 diabetes at 5 years. We previously reported cost-effectiveness based on 2-year results. We now present an updated cost-effectiveness analysis, based on available 5-year data.

methodsA lifetime cost-effectiveness analysis was conducted using the 5-year data from DiRECT, including time to relapse from remission from type 2 diabetes, intervention costs (practitioner appointment visits, low-energy formula diet sachets), routine healthcare resource use (primary, secondary, and tertiary care contacts), medications (anti-hypertensive and anti-diabetic medicines), and quality of life (EuroQol EQ-5D-3L). Modelling assumed that all those in remission at 5 years would relapse after a maximum of 10 years.

resultsTotal (discounted) healthcare cost-savings (excluding intervention costs) per participant over 5 years amounted to £2091. On average, healthcare costs per annum were ~£480 per participant lower in the intervention arm (p < 0.05). Intervention resource use beyond 2 years added relatively little to the total intervention cost (set-up, formula diet and practice visits), which amounted to £1691 (95% CI: £1566, 1822) per participant over 5 years. Reduced hospital admissions accounted for the major part of this saving, with the remainder being across primary and secondary care, and anti-diabetic and anti-hypertensive medications. Remission in DiRECT was associated with a significant improvement in quality of life, and the intervention arm was modelled to achieve both cost-savings of ~£400 and quality adjusted life year gains of 0.043 over 5 years, with further benefits due to reduced mortality in remission. Over the full lifetime horizon of the analysis the intervention was modelled to produce 0.08 incremental QALYs, saving £496 per participant.

conclusionsThe costs involved in achieving remissions from type 2 diabetes with the Counterweight-Plus diet programme were offset within 5 years through reduced healthcare resource use. Though remission may ultimately relapse, sustained weight loss brings other longer term health gains. The intervention, even using one-to-one face-to-face contacts rather than remote delivery, which is increasingly adopted, generated both health gains and cost-savings compared with current best practice.

Indexed as

Diabetes Mellitus, Type 2ObesityWeight Reduction ProgramsCost-Benefit AnalysisCost-Effectiveness AnalysisFemaleFollow-Up StudiesHealth Care CostsHumansHypoglycemic AgentsMaleMiddle AgedQuality-Adjusted Life YearsQuality of LifeRemission InductionWeight LossHypoglycemic Agentsdiabeteseconomicstype 2 diabetes

Identifiers

PMID41904649
PMCPMC13170983

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.