For the last 15 years Professor Lean has been working on research into type-2 diabetes and its remission using a structured diet programme developed in Scotland and used in the landmark Diabetes Remission Clinical Trial (DiRECT), funded by Diabetes UK. This management approach has now been adopted for routine care in every Scottish NHS Health Board, and by NHS England, Wales and Northern Ireland, and in other countries around the world.

Research in DiRECT showed that type-2 diabetes is mainly driven by body fat accumulation damaging vital organs, and is best treated through weight loss as early as possible.

Sufficient weight loss stops the disease process in its tracks, potentially achieving remission (defined as no longer diabetic and not requiring medication).

Halting the progression of type-2 diabetes, alongside preventing it from developing, are goals not only for patients but also healthcare systems around the world. Type-2 diabetes is now one of the most expensive diseases, through the escalating costs of new medications and the costs of its chronic complications which include blindness, kidney failure, amputations, infections and premature dementia.

Diabetes in Nepal

Until recently type-2 diabetes was rare in Nepal. Nepalese people, along with other Asian and indigenous peoples, are genetically predisposed to type-2 diabetes but the disease only emerged after energy-dense processed foods were introduced to the country, and people started to gain weight. Now, the country has a high prevalence of the disease and its disabling complications – about one in five people aged over 40 have it, and medication-based diabetes treatments are unaffordable for most people.

The CoDIAPREM Project

The CoDIAPREM (Community-based Diabetes Prevention and Remission) project will test a community-led drive to re-adopt Nepal’s traditional foods to achieve and maintain lower body weight, which appears to have prevented most diabetes in the past. The research team will assess the diet’s ability to prevent the onset of type-2 diabetes, and also its ability to achieve long-term remissions, without the need for medications, in people discovered to have already developed the disease. Pilot research in Nepal demonstrating remissions of diabetes has been very promising, offering a solution to type-2 diabetes at very low cost and with minimal health professional input. 

CoDIAPREM was fully assessed and approved for funding by the highly competitive NIHR Global Health Research Programme, but in July 2025, government funding for that Programme was withdrawn and the Foundation agreed to fund the four year trial.