ARIADNE: A Study of Weight Loss for Diabetes Treatment and Wellbeing

The Impact of Low-energy totAl Diet Replacement With Behavioural Support for remIssion of Type 2 DIAbetes on disordEred eatiNg: the ARIADNE Randomised Non-inferiority Controlled Trial

The NHS has started a trial-run of a weight loss programme replacing food with 800-calorie shakes and soups for 3 months, offered to people with newly diagnosed type 2 diabetes (T2D) to lose weight and put their diabetes into remission. Some healthcare professionals and charities are sceptical about the programme's effect on people's mental health. They fear it may trigger people to have a negative relationship with food (disordered eating). Some studies show indirectly that these programmes are somewhat safe; however it is not known for sure if it could affect people's relationship with food for the worse. Investigators will invite 56 people with T2D and disordered eating (picked up by questionnaires they will fill in) to participate in a trial. Of these participants, 28 will get TDR and the rest will get their standard care. Investigators will then measure how their scores of disordered eating change at 1, 3, 4, 6, 12 and 24 months. Investigators also plan to analyse the recorded sessions to better understand participants' experiences using TDR and their thoughts about eating and body image. This study will help shed light on how safe this type of diet is for people with disordered eating. It may lead to screening for eating disorders if TDR becomes standard care. If concerns are unfounded, it can reassure people with type 2 diabetes and healthcare professionals.

Study Overview

• Status: Active, not recruiting
• Conditions: Obesity; Overweight and Obesity; Diet Habit; Type2diabetes; Disordered Eating
• Intervention / Treatment: Behavioral: Low calorie total diet replacement; Other: Usual care

• Study Type: Interventional
• Enrollment (Actual): 56
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Oxford, United Kingdom, OX26GG
    • Nuffield Department of Primary Care Health Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Willing and able to give informed consent, can communicate in English
• Age between 18 and 65 years inclusive
• Live in England
• BMI ≥27 kg/m2 or higher (adjusted to ≥25 kg/m2 for people of Black, Asian and minority ethnic origin)
• Diagnosed with T2D within 6 years prior to the day of screening
• Global EDE-Q scores ≥2.67
• To have an HbA1c taken in the last 12 months
• Latest HbA1c ≥43 mmol/mol (6.1%) and ≤87 mmol/mol (10%) if on diabetes medication OR latest hbA1c ≥ 48 mmol/mol (6.5%) and ≤87 mmol/mol (10%), if not on diabetes medication.
• If diagnosed with type 2 diabetes more than 1 year since day of screening, the participant must have attended their GP surgery for monitoring/ diabetes review when last offered
• Commit to continue annual reviews with their GP, even if T2D remission is achieved

Exclusion Criteria:

The participant must not enter the study if ANY of the following apply:

• Current or previous clinical diagnosis of an eating disorder
• Combination of EDE-Q ≥4 AND a CIA score ≥16 at screening
• Currently participating in a structured weight loss programme or self-reporting that they have lost >10% of their body weight in the last 3 months
• Insulin use
• Known kidney disease of stage 3/4/5 or eGFR <60 mls/min/1.73 m2 within the last 12 months
• Active substance use disorder
• Active cancer other than skin cancer
• Known proliferative retinopathy that has not been treated
• Porphyria
• Undergone or is awaiting bariatric surgery
• Myocardial infarction or stroke within previous 6 months
• Severe heart failure defined as equivalent to the New York Heart Association (NYHA) grade 3 or 4
• Active liver disease (not including non-alcoholic fatty liver disease)
• Pregnant, breastfeeding, or planning to become pregnant during the course of the study
• Soy or milk or fish allergy, lactose intolerance, or following a vegan diet
• People currently participating in another study or clinical trial of a CTIMP/non-CTIMP

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention- Low calorie diet/ Total diet replacement; Participants in the intervention group will be offered a dietitian-delivered intervention over 6 months, similar to the NHS pilot of low calorie diets for type 2 diabetes remission. The intervention starts with 12 weeks of low-energy total diet replacement (approx. 860 kcal/day) in a nutritionally replete package of soups, shakes, and bars. It continues with stepped food reintroduction (maximum 6 weeks) as a low-calorie, nutrient-rich diet personalised to the individual participant circumstances and preferences, and weight maintenance (6 weeks).	Behavioral: Low calorie total diet replacement; Summary; Weeks 1-12: TDR phase; Weeks 13-14: Food reintroduction phase I; Weeks 15-16: Food reintroduction phase II; Weeks 17 till 20: Food reintroduction phase III; Weeks 21 till 24: Maintenance phase
Other: Control- usual care; Participants allocated to the control group will be offered and continue benefiting from standard care. Participants will not be stopped from pursuing any behavioural weight management programme but if they do, this will be recorded. Participants will be offered an invitation to a 30-45' 1:1 session with the research dietitian at the end of the study to provide help and signposting as required for the management of their diabetes.	Other: Usual care; Participants allocated to the control group will be offered and continue benefiting from standard care. Participants will not be stopped from pursuing any behavioural weight management programme but if they do, this will be recorded.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Global score of disordered eating psychopathology	Between group difference in scores of disordered eating psychopathology, as measured by the global score of the self-administered Eating Disorders Examination questionnaire (EDE-Q). Scores range from 0 to 6, with higher scores indicating more severe eating disorders psychopathology.	24 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Global score of disordered eating psychopathology	Between group difference in scores of disordered eating psychopathology, as measured by the global score of the self-administered Eating Disorders Examination questionnaire (EDE-Q). Scores range from 0 to 6, with higher scores indicating more severe eating disorders psychopathology.	4, 12, 16, 52 and 104 weeks
Subscales of disordered eating psychopathology	Between group difference in sub-scale scores of disordered eating, assessed by the subscale scores of Eating Disorders Examination questionnaire (EDE-Q): Restraint, Eating concern, Shape concern, Weight concern. Subscale scores reflect the severity of the specific characteristics of disordered eating. Higher scores in each subgroup indicate more severe psychopathology.	4, 12, 16, 24, 52 and 104 weeks
Psychosocial impairment	Between group difference in psychosocial impairment, assessed by the self-administered clinical impairment assessment (CIA) questionnaire. The CIA measures the severity of psychosocial impairment due to eating disorder features, and scores range from o to 48, with higher scores indicating more severe impairment.	4, 12, 16, 24, 52 and 104 weeks
Weight	Changes between group, assessed by self-weighing	4, 12, 16, 24, 52 and 104 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety/ New cases needing referral to specialist services	To examine the safety signals of TDR in people with disordered eating, by collecting the incidence of cases of high suspicion of a new eating disorder, measured by referral of participant to see their GP for further referral to specialist services	Through study completion, an average of 1 year
Changes in medication	Changes in diabetes medication between TDR and control	12, 24, 52 and 104 weeks
Changes in quality of life	Between group difference in quality of life, measured by the Problem Areas In Diabetes (PAID) Scale. PAID is used to measure distress related to emotions, treatment, food and social support in living with diabetes. Scores range from 0 to 100, with higher scores indicating higher diabetes distress.	12, 24, 52 and 104 weeks
Process evaluation of significant changes in disorder eating psychopathology during the intervention	Qualitative analysis of transcribed sessions with the dietitian in people with significant EDE-Q changes (more than 1 SD)	Through study completion, an average of 2 years

Collaborators and Investigators

• Sponsor: University of Oxford

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2023
• Primary Completion (Actual): March 1, 2024
• Study Completion (Estimated): September 1, 2025

Study Registration Dates

• First Submitted: January 25, 2023
• First Submitted That Met QC Criteria: February 15, 2023
• First Posted (Actual): February 24, 2023

Study Record Updates

• Last Update Posted (Estimated): July 8, 2025
• Last Update Submitted That Met QC Criteria: July 2, 2025
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Endocrine System Diseases; Nutrition Disorders; Metabolic Diseases; Overnutrition; Body Weight; Glucose Metabolism Disorders; Overweight; Obesity; Diabetes Mellitus, Type 2; Diabetes Mellitus
• Other Study ID Numbers: R82152/RE004

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No