Summary: In Chinese adults with type 2 diabetes, a 6-month low-calorie diet achieved diabetes remission in 56% of participants, with formula-based and real food-based diets performing equally well and notable individual variability in response.
PICO Summary
| Element | Detail |
|---|---|
| Population | Chinese adults with type 2 diabetes (BMI 24–45 kg/m², HbA1c 6.5–12.0%); n=41. |
| Intervention | Low-calorie diet, 815–835 kcal/day for 3 months then a 3-month maintenance phase; formula-based (LCFD, n=21) and real food-based (LCRFD, n=20) variants. All anti-diabetic drugs stopped on day 1. |
| Comparison | LCFD versus LCRFD head-to-head; remission rates also benchmarked against published data from other populations. |
| Outcome | 56.1% achieved T2D remission at 6 months; 39.0% lost ≥10% body weight. Significant reductions in liver and pancreatic fat. No difference between LCFD and LCRFD. Nonresponders had longer duration, poorer control, and lower beta-cell function. |
Expert Commentary
I have watched the remission story unfold largely through a Western lens, and a quiet worry has sat at the back of my mind that the DiRECT findings might not transfer to my leaner Asian patients, whose diabetes often looks more like beta-cell failure than pure insulin resistance. This study is reassuring precisely because it addresses that worry directly, and a remission rate of 56% in Chinese adults is not a watered-down version of the Western result, it is comparable. What I find genuinely useful is that formula and ordinary food worked equally well, because it means I can shape a programme around what a patient will actually stick to rather than insisting on meal-replacement products. The honest limitation is the size, just 41 patients, and the lack of long-term durability data, so I am cautious about promising my patients that remission will last. Can I use this with my patients? Yes, and with more confidence in my Chinese and other Asian patients than I had a year ago, particularly those with shorter-duration disease and preserved beta-cell function. I would now like to see the durability data that tells me how many are still in remission at two years.
References
Liu Z, Feng N, Wang S, et al. Low-calorie diets and remission of type 2 diabetes in Chinese: phenotypic changes and individual variability. Nutr J. 2025;24(1):42. doi:10.1186/s12937-025-01101-z