A RECENT evaluation of the English National Health Service (NHS) Type 2 Diabetes Path to Remission (T2DR) programme has revealed that participants on the ‘soups and shakes’ diet were able to experience Type 2 diabetes remission and an average weight loss of 16kg.
The T2DR programme is an initiative led by Diabetes UK and NHS England, inspired by the DiRECT study, and focuses on total diet replacement (TDR) as a central component of a 12-month behavioural intervention aimed at supporting significant weight loss in patients with newly diagnosed Type 2 diabetes.
The T2DR programme targets adults aged 18–65 years who have been diagnosed with Type 2 diabetes within the past 6 years. Participants undergo an initial 3-month period of TDR, followed by continued support to sustain their weight loss over the remaining 9 months. The primary goal of the programme is to achieve diabetes remission, defined as having two consecutive HbA1c measurements below 48 mmol/mol, taken at least 3 months apart, without the use of glucose-lowering medications for 3 months prior to the first HbA1c measurement.
Data from the programme, collected until December 2022, revealed that out of 7,540 people referred, 1,740 initiated TDR before January 2022, giving them a full 12-month period to complete the programme. Of these, 960 participants (55%) completed the programme, demonstrating an average weight loss of 9.3% (10.3 kg). For the 710 participants who started the programme and had complete HbA1c data, 27% achieved remission with an average weight loss of 13.4% (14.8 kg). Among those who completed the programme and had the necessary HbA1c data, the remission rate rose to 32%, with a mean weight loss of 14.4% (15.9 kg).
The findings show that, while the T2DR programme can lead to significant weight loss and diabetes remission outside of controlled research settings, the rates of remission and data completeness are lower in the real-world implementation compared to randomised controlled trials. Nonetheless, this large-scale, nationwide effort demonstrates that Type 2 diabetes remission is achievable through structured, at-scale interventions within the NHS framework. However, further work is needed to enhance data collection and programme efficacy.
Laith Gergi, EMJ
Reference
Valabhji J et al. Early findings from the NHS type 2 diabetes path to remission programme: a prospective evaluation of real-world implementation. Lancet Diabetes Endocrinol. 2024;S2213-8587(24)00194-3.
