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Importance of Clinical Trials and Guideline Recommendations
Panelists discuss how ADA recommendations emphasize treating diabetes as part of overlapping conditions requiring cardiovascular and kidney protection, moving beyond just glycemic control to comprehensive care that addresses the whole person.
EP: 1.Hormonal Adaptations in Type 2 Diabetes and Obesity
EP: 2.Importance of Clinical Trials and Guideline Recommendations
EP: 3.Barriers Associated with Guideline-Directed Care
EP: 4.The Role of Weight Management and Glycemic Control in the Management of Type 2 Diabetes
EP: 5.Improving Patient Outcomes Beyond Glycemic Control
EP: 6.Taking a Cardiometabolic Health Approach in Patients with Type 2 Diabetes
EP: 7.Seamless Management Between Primary Care Providers and Specialists
EP: 8.Supporting Patients and Primary Care Providers
EP: 9.Optimizing the Clinician-Patient Relationship
EP: 10.Overcoming Weight Bias in Clinical Practice
EP: 11.Creating a Positive Culture Around Weight Discussions
EP: 12.Leveraging Registries and Data Analytics
EP: 13.Structured Care Pathways and Predictive Modeling
EP: 14.Additional Clinical Considerations for the Management of Obesity
The DiRECT Trial and Weight Management Programs
The DiRECT trial conducted in the UK was inspired by patients' most common question: "Is diabetes reversible?" This landmark study incorporated the Counterweight Program into primary care settings, demonstrating that structured weight management interventions can lead to diabetes remission. After 12 months, approximately 46% of relatively newly diagnosed diabetes patients who were not on insulin achieved hemoglobin A1c levels below 6.5%, technically achieving remission.
The program involved meal replacements with liquid diets for up to 20 weeks, gradual food reintroduction, and frequent counseling support. Patients who lost 15-20% of their starting weight were most likely to maintain remission. However, the challenge of maintaining weight loss became evident as remission rates decreased to approximately 12-15% by five years, highlighting the difficulty of sustained lifestyle changes.
The trial proves that diabetes remission is possible through lifestyle interventions, but successful programs must be accessible, cost-effective, and capable of re-engaging patients throughout their lives. The research emphasizes the importance of early intervention for weight reduction to improve metabolic parameters and potentially achieve diabetes remission, while acknowledging the ongoing challenge of long-term weight maintenance.
Integrated Care for Chronic Conditions: A Randomized Care Management Trial
December 3rd 2025The authors sought to understand the differential impact of payer-led community-based care management approaches on stakeholder-oriented outcomes for publicly insured adults with multiple chronic conditions.
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Managed Care Reflections: A Q&A With A. Mark Fendrick, MD, and Michael E. Chernew, PhD
December 2nd 2025To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The December issue features a conversation with AJMC Co–Editors in Chief A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design and a professor at the University of Michigan in Ann Arbor; and Michael E. Chernew, PhD, the Leonard D. Schaeffer Professor of Health Care Policy and the director of the Healthcare Markets and Regulation Lab at Harvard Medical School in Boston, Massachusetts.
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