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Aims/Hypothesis: To assess whether a structured weight management programme incorporating a total diet replacement (TDR (3-5 months~ 850kcal/day formula diet) weight loss phase is acceptable to people of South Asian ethnicity, and can achieve type 2 diabetes (T2D) remissions similarly to other populations.

Methods: Adults of South Asian ethnicity, aged 18-65 years, with T2D for≤ 4 years, and BMI 25-45kg/m 2 were recruited from primary care and social media, and randomised to commence TDR either immediately (iTDR)), or delayed (dTDR) for 3-5 months as a usual care control arm during this period. Intervention effects were tested in randomised comparisons, and in an expanded observational analysis including both iTDR and dTDR groups. Acceptability was explored by questionnaire and weight change.

Results: Twenty-five eligible individuals were recruited. Mean baseline (SD) age was 45· 8 (11· 1) years, weight 88· 2 (13· 7) kg, BMI 32· 1 (3· 8) kg/m 2, HbA1c 60· 4 (11· 3) mmol/mol, liver fat by MRI 15· 6 (9· 4)%. In the RCT, mean (SD) weight change after TDR was-7· 7 (7· 2)% in the intervention group (n= 13), and-1· 2 (1· 4)% in the usual-care control group (n= 12)(p= 0· 005), with T2D remission achieved by 5/13, compared to 0/12 respectively (p= 0· 039). In the observational study, 23/25 started TDR and 19/23 participants completed the TDR phase. Median time spent in TDR was 105 days (IQR 77-134 days). T2D remission was achieved in 10/23 (43%), and weight changes were concordant with the RCT. Overall, 8/23 (35%) lost over 10% bodyweight. Absolute liver fat proportion near halved from 15· 3% at the start of TDR to 8· 6 …