Ethnic differences in the pathophysiological response to weight loss in Black African and Caribbean and White European people with type 2 diabetes

Total diet replacement (TDR) interventions may be less effective at promoting type 2 diabetes (T2D) remission in people of Black African and Caribbean (BA) ethnicity, who experience disproportionately high rates of T2D. This may be because less weight loss is achieved, or because of ethnic differences in the pathophysiology of T2D, where hepatic fat is a less important driver of T2D compared with people of White-European (WE) ethnicity. It is unclear whether weight loss responses to TDR differ between BA and WE adults, and whether the physiological responses to weight loss differ according to ethnicity. We will conduct a two-group trial, investigating ethnic differences in the effect of 12-week TDR on i) weight and glycaemic control and ii) the underlying physiology of T2D in BA and WE men and women. BA (n=27) and WE (n=27) adults, aged 40-65 years, BMI 27-45 kg/m2, and diagnosed with T2D within 6 years, will be recruited. We will assess change in glycaemic control (HbA1c; primary outcome), body weight, visceral, hepatic and pancreatic fat (by magnetic resonance imaging), insulin sensitivity and β-cell function. Our findings will inform current NHS T2D remission services and contribute to development of more targeted interventions for BA populations.