NHS Type 2 Diabetes Path to Remission (T2DR) programme

• a national prospective service evaluation of NHS Type 2 Diabetes Path to Remission (T2DR) programme implementation was undertaken:
  • T2DR cohort has been defined as:
    • people in England aged 18-65 years and diagnosed with type 2 diabetes in the last 6 years
    • primary outcome was remission of type 2 diabetes at 1 year, defined as two HbA1c measurements of less than 48 mmol/mol recorded at least 3 months apart with no glucose-lowering medications prescribed from 3 months before the first HbA1c measurement, and the second HbA1c measurement recorded 11-15 months after the programme start date
    • programme was delivered by 10 Integrated Care Boards following the national service specification of TDR, food reintroduction, and weight maintenance, with a minimum of 20 sessions (eight while on total dietary replacement (TDR), four in food reintroduction, and eight in the weight maintenance phase) and a total programme duration of 12 months:
      • TDR phase was for 12 weeks with a total daily calorie intake of around 800–900 kcal, comprised of nutritionally formulated products such as soups, shakes, and bars, alongside weekly coaching sessions for the first 4 weeks and fortnightly sessions for the subsequent 8 weeks.
      • followed by a period of food reintroduction for 4–6 weeks, featuring at least four coaching sessions, focusing on transitioning from TDR to a healthy balanced diet and setting individualised targets for energy intake and weight
      • final phase of the programme, titled weight maintenance, supported attainment of these goals alongside monthly coaching sessions directed at behaviour change and encouragement of physical activity
    • outcomes were assessed in two ways: for all participants who started TDR on the 12-month programme before January, 2022, for whom there were no missing data; and for all participants who started TDR on the 12-month programme before January, 2022, and had completed the programme (ie, had a valid weight recorded at month 12) by Dec 31, 2022, for whom there were no missing data
    • study (n=1710) show for those with two HbA1c measurements recorded at applicable timepoints, 27% who undertook programme and 32% of subgroup who completed programme, had remission of type 2 diabetes at 12 months, with mean weight loss of 9.4kg & 10.3kg, respectively

Reference:

1. Valabhiji J et al. Early findings from the NHS Type 2 Diabetes Path to Remission Programme: a prospective evaluation of real-world implementation. Lancet Diabetes and Endocrinology August 5th 2024