Maximising the potential of type 2 diabetes remission: scale up and sustainability considerations from the DiRECT-Aus implementation trial

Background: Approximately 500 million people worldwide live with type 2 diabetes mellitus. The UK's 'Diabetes Remission Clinical Trial' (DiRECT) is a potential novel method for care. An Australian trial of DiRECT (DiRECT-Aus) showed that 56% of participants achieved diabetes remission at 12 months. We explored the experiences of patients, clinicians and trial partners involved in DiRECT-Aus to ascertain the acceptability and feasibility of DiRECT-Aus, as well as factors influencing implementation, to inform recommendations for sustainable scale up into mainstream primary care. Methods: This qualitative implementation research conducted within a constructivist paradigm involved semi-structured interviews with key stakeholders. Data analysis followed an inductive thematic approach, informed by the Consolidated Framework for Implementation Research. Results: Patients (n = 14), general practitioners (n = 3), practice nurses (n = 6), dietitians (n = 7) and DiRECT-Aus trial partners (n = 5) were interviewed. We identified four core components of DiRECT-Aus that are essential for implementation and scale up. They were: (1) access to very low-energy diet products; (2) high frequency of contact with the dietitian; (3) dietitian's clinical knowledge and patient-centred practice; and (4) absence of financial costs to patients. Several additional factors that could support implementation and suggested funding models are described. Conclusions: This study concludes that DiRECT-Aus was acceptable and feasible to patients and clinicians.