One-third of NHS diet programme participants achieve type 2 diabetes remission, study finds
A recent study published in The Lancet Diabetes & Endocrinology has revealed that approximately one-third of participants in the National Health Service (NHS) shakes and soups diet programme in England have achieved remission from type 2 diabetes. This study, which evaluated the effectiveness of total dietary replacement (TDR) for insulin-independent diabetes remission, sheds light on the potential of structured diet interventions in managing type 2 diabetes on a large scale.
The escalating rates of diabetes in the United Kingdom have led the NHS to implement the Type 2 Diabetes Path to Remission (T2DR) initiative. This programme is centred around a low-calorie, micronutrient-rich diet, which has been shown to result in significant weight loss and sustained remission of diabetes. While clinical trials have demonstrated the efficacy of such dietary interventions, their effectiveness in broader, real-world contexts has remained unclear until now.
The T2DR programme is designed to help individuals lose weight, maintain that weight loss, and reduce their reliance on glucose-lowering medications. The programme comprises 20 sessions divided into three phases: the TDR phase, the food reintroduction phase, and the weight maintenance phase. The TDR phase, lasting 12 weeks, focuses on strict calorie intake regulation accompanied by coaching. Following this, the food reintroduction phase spans 4 to 6 weeks, during which participants are guided on healthy eating habits and goal-setting. The final phase, weight maintenance, involves monthly coaching sessions aimed at behaviour modification and encouraging physical activity to help participants sustain their weight loss and health improvements.
This study utilised prospective, national-level data to assess whether the NHS’s T2DR programme effectively promotes remission of type 2 diabetes. Researchers analysed data from English adults aged between 18 and 65 who had been diagnosed with type 2 diabetes within the previous six years and were referred to the T2DR programme by their general practitioners between September 2020 and December 2022. Participants included in the study had a body mass index (BMI) of at least 27 kg/m² for white individuals, with a lower threshold of 25 kg/m² for individuals of other ethnicities.
To determine the programme’s effectiveness, the researchers linked programme data with records from the National Diabetes Audit (NDA). They specifically examined glycated haemoglobin (HbA1c) levels and the use of oral hypoglycaemic medications. Eligible participants had recent HbA1c levels ranging from 43 to 87 mmol/mol if they were on glucose-lowering medications, or 48 to 87 mmol/mol if they were not.
The primary outcome of the study was diabetes remission at one year, defined by two HbA1c readings below 48 mmol/mol taken at least three months apart, without the use of glucose-lowering medications. These readings were collected from three months before the initial HbA1c measurement up to 15 months later. Secondary outcomes included the absolute and percentage changes in body weight, as well as the proportion of participants achieving at least 10% and 15% weight loss within one year.
The study focused on participants who began the TDR-based programme before 2022 and had completed it by December 2022, which included having their body weight recorded at the one-year mark. Researchers employed multivariate regression analyses to account for various factors, including demographic characteristics (age, gender, socioeconomic status, and ethnicity), clinical variables (duration of diabetes, baseline BMI, and HbA1c levels), and details about the programme’s delivery method and provider. Sensitivity analyses were also conducted to evaluate different timings for subsequent HbA1c measurements, ranging from 11 to 15 months after the initial reading.
Between September 2020 and December 2022, a total of 7,540 individuals were referred to the T2DR programme. The average age of participants was 50 years, with 43% being male and 64% identifying as white. Of these, 1,740 individuals initiated the TDR phase before 2022, with the aim of completing the programme within one year. Among those who started the programme before 2022, 55% (960 individuals) successfully completed it.
Out of all participants referred to the programme, 34% were not taking glucose-lowering medications, 50% were on one medication, and 16% were on two or more, with metformin being the most commonly prescribed.
The mean weight loss among the 1,710 participants who started the programme before 2022 was 9.40 kg, or 8.3% of their initial body weight. For the 945 participants who completed the programme, the average weight loss increased to 10 kg, or 9.3% of their starting weight. Among those with at least two HbA1c readings, 27% (190 individuals) achieved diabetes remission, with an average weight loss of 15 kg, or 13%. Of the 945 individuals who completed the programme, 48% (450 participants) had two HbA1c readings available, and of these, 32% (145 individuals) achieved remission, with an average weight loss of 16 kg, or 14%.
Furthermore, 42% of the 945 individuals who completed the programme lost at least 10% of their baseline weight, and 20% lost at least 15%. Among those who achieved remission, 76% (110 participants) lost at least 10% of their baseline weight, and 45% (65 participants) lost at least 15%. Sensitivity analyses produced consistent results, reinforcing the findings.
The study concluded that 27% of participants in the NHS T2DR programme achieved diabetes remission, demonstrating that remission is possible outside of controlled research settings with widespread implementation. However, remission rates in real-world applications are lower, and data collection is more limited compared to randomised controlled trials. These findings are significant as they provide valuable insights for policymakers regarding the operational effectiveness of the TDR approach and its potential impact on public health.
