The clinical and operational core of the ThriveAB venture is the direct implementation of the protocol validated by the Diabetes Remission Clinical Trial (DiRECT), led by Professor Roy Taylor at Newcastle University.
This "open-source" model provides a meticulously researched, evidence-based foundation, eliminating the need for novel clinical development and allowing the business to focus on superior execution and patient experience.
Deconstructing the Evidence
In the initial randomized controlled trial, 46% of participants in the intervention group achieved remission of T2D at 12 months, defined as achieving a glycated hemoglobin (HbA1c) level below 6.5% (<48 mmol/mol) after being off all antidiabetic medications for at least two months.
This compares to only 4% in the control group receiving standard guideline-based care—a more than 10-fold difference in outcomes.
The results demonstrated a powerful correlation with weight loss: remission was achieved by 86% of participants who successfully lost 15 kg or more, confirming that significant weight loss is the primary mechanism of action.
The Three-Phase Protocol
1 Total Diet Replacement (TDR) - Weeks 1-12
Objective: Achieve rapid, significant weight loss (>15 kg target) and induce metabolic remission
Protocol Details:
- Replace all regular food with nutritionally complete, low-calorie formula diet (825-853 kcal/day)
- Meal replacement shakes and soups consumed for 12-20 weeks
- Critical first step: Physician-supervised withdrawal of all antidiabetic and antihypertensive medications to prevent hypoglycemia and hypotension
- Weekly to bi-weekly check-ins with healthcare team
- Focus on managing side effects and maintaining motivation
2 Stepped Food Reintroduction (FR) - Weeks 13-18
Objective: Gradually reintroduce whole foods without compromising weight loss
Protocol Details:
- 2-8 week structured reintroduction period
- Guidance from healthcare professionals (nurses or dietitians)
- Education on portion control and balanced nutrition
- Learning to navigate real-world food choices
- Establishing sustainable eating patterns
3 Structured Weight Loss Maintenance (WLM) - Months 5-12+
Objective: Maintain weight loss and prevent regain through long-term support
Protocol Details:
- Long-term phase with ongoing structured support
- Regular check-ins and progress monitoring
- Physical activity goals and progression
- Relapse management strategies
- Community support and peer accountability
Long-Term Outcomes & Durability
A critical question for any remission program is the durability of its effects. The DiRECT trial's long-term follow-up data provides crucial insights:
12 Months
46%
Remission rate in intervention group
24 Months (2 Years)
36%
Sustained remission—a remarkable outcome for a condition previously considered permanent
5 Years
13%
Still in remission with low-intensity support
The decline in remission rates over time (46% → 13%) is not a failure but a clear illustration of the challenge of long-term weight loss maintenance. This reality represents the single greatest business opportunity for the venture. The initial 12-month program proves remission is possible. The long-term maintenance challenge justifies a premium, subscription-based ThriveAB+ membership.
Translating the Model to the Alberta Context
The DiRECT trial was intentionally designed to be delivered within a routine primary care setting by existing staff (practice nurses and dietitians), proving its feasibility outside of highly specialized academic centers.
Key Adaptations for Alberta:
Physician-Led Component
Non-negotiable requirement for initial assessment and safe de-prescription of medications. Provides key differentiator from non-medical programs.
Team-Based Delivery
Hybrid approach maximizes professional value while adhering to scope of practice. Physician focuses on high-leverage activities; allied health delivers ongoing support.
Group Delivery Model
Educational and support components delivered in group settings (10-15 participants). Enhances operational leverage and builds peer community.
Interdisciplinary Team
RN/CDE (Certified Diabetes Educator), Registered Dietitian, Kinesiologist. Each operating at top of license with specialized expertise.
The optimal model for Alberta is a tiered delivery system that ensures the most expensive resource (the physician) is used most efficiently, allowing the clinic to serve a larger patient panel, maintain profitability, and scale effectively.
Clinical Credibility & Evidence Base
The DiRECT protocol is not experimental medicine—it is a proven, evidence-based intervention validated through rigorous randomized controlled trials and published in top-tier medical journals.
Key Research Milestones:
- Published in The Lancet (2017): Primary outcomes at 12 months
- Published in The Lancet Diabetes & Endocrinology (2019): 2-year follow-up results
- Published in Diabetic Medicine (2023): 5-year extension data
- Health economic analysis in UK NHS: Cost-saving within 6 years
Clinical Lead: Professor Roy Taylor, Newcastle University Magnetic Resonance Centre. Pioneer in understanding the pathophysiology of T2D remission through weight loss.
Source: DiRECT trial publications, Newcastle University research program