Using data from the DiRECT (very low-calorie, meal-replacement) and Virta (very low-carb, real-food) interventions, Zoë Harcombe compares the studies across both protocol and outcomes at one and two years. Although DiRECT was presented as the “randomized” option, both trials allowed participants to know their assigned treatment before enrolling. Virta included more complex patients—many on insulin and with a much longer duration of diabetes—yet still achieved greater reductions in HbA1c, more weight loss (absolute and percent), fewer medications, and similar or better retention at one year. At two years, both groups saw some regain, but Virta participants maintained superior improvements, leading Harcombe to conclude that low-carb should be offered to every patient considering severe calorie restriction—and that patients should be shown the comparative data before choosing an approach.

https://www.zoeharcombe.com/2020/09/low-calorie-vs-low-carbohydrate-for-t2d-remission-direct-vs-virta/