In DiRECT, we aimed to establish whether a structured programme, delivered by primary care nurses or dietitians, could achieve and maintain remission of type 2 diabetes. Remission (off all antidiabetic drugs) occurred in 46% of participants after 12 months. 1 Unlike previous smaller, nonrandomised studies from specialist centres, the findings from DiRECT provide hard evidence of efficacy to inform decisions about provision of health care. No previous randomised trial in primary care has been specifically powered for remission of type 2 diabetes as its primary outcome. Ahmad and Alfaris are correct that sustainability of remission is crucially important, as we made clear in our Article. DiRECT was planned with 2 years of followup, and fun ding has now been granted for an additional 3 years. The onset of vascular complications is clearly linked to disease duration, so reducing the number of years with diabetes, through primary prevention or through a period of remission, is expected to restrict the longterm disabling consequences of diabetes. On the basis of available evidence, it is hard to argue that people with type 2 diabetes should not be offered the opportunity to use a nonsurgical, nonpharmaceutical treatment that has been shown to provide at least 1 year of remission for almost half of patients, and has improved diabetes and riskfactor control on fewer medications for other patients. Relatively little attention has been given to longterm maintenance of weight loss, 2 although DiRECT was informed by metaanalysis. 3 We agree that the topic should be a high priority for research investment. Very low calorie diet (VLCD) re fers to energy intake less than 800 kcal per day, so by definition, DiRECT used a low calorie diet for initial weight loss, not VLCD. The literature review by Saris4 quoted by Ahmad and Alfaris showed no benefit from 400 kcal per day VLCDs compared with low calorie diets of more than 800 kcal per day, but it did show a clear benefit of active followup after weight loss. The DiRECT CounterweightPlus programme pro vides guided stepped food re introduction and regular sup port to optimise maintenance, thus differing markedly from a VLCD alone.