The NCL Low-Calorie Diet Service for people with type 2 diabetes launched across NCL in November 2020, as part of an NHS England (NHSE) pilot programme. NCL is one of ten sites across England that was selected to roll-out the new, innovative and free service. A total of 750 places will be available.

The service, offered by Xyla Health and Wellbeing, provides a digitally-led one-year programme to support healthier lifestyles, weight loss and remission of type 2 diabetes. The programme is based on two large studies which showed that, as a result of low-calorie diet treatment, people living with type 2 diabetes who were overweight could improve their diabetes control, reduce diabetes-related medication and even achieve remission.

Programme overview

The one-year programme consists of 12 weeks of low-calorie total diet replacement (shakes and soups, products provided by Xyla Health and Wellbeing) followed by reintroducing food, focusing on movement and maintaining a new healthy eating lifestyle.

The programme: 

• combines specialist nutrition, psychology and physical activity
• supports rapid weight loss and long-term behaviour change
• is delivered entirely remotely via the Xyla Health and Wellbeing app, with supporting resources and 1-2-1 telephone coaching
• is delivered by Xyla Health and Wellbeing, GPs, practice nurses, diabetes practitioners, dietitians, clinical psychologists and exercise specialists.

The NCL Low-Calorie Diet Programme is eligible for the additional Weight Management DES payment upon referral (2020-2023).

Referrals

Referrals to the service are made from primary care. To reduce workload on practices, the NCL Low-Calorie Diet Programme steering group advises that practices may wish to operate at a PCN level to identify eligible patients and make referrals (e.g. the PCN practice-based pharmacist could lead on engaging with the service).

Low-calorie diet eligibility searches are now available on practice clinical systems to support identification of appropriate patients. It is important that all patients who are referred are engaged and committed to taking part in the 12-month programme. Some practices may have already been contacted by interested patients. It is recommended to get back in touch with engaged patients to discuss eligibility for the service. 

Useful resources

See Downloads for medication changes guidelines, practice patient allocation profiles and other useful resources, including programme FAQs.

See Related Videos for the recording of the Low-Calorie Diet Programme referral training event that took place 3 November 2022.

Patient resources include:

• Patient information leaflet
• The Latest from the NHS Low-Calorie Diet Pilot Programme Newsletter, June 2021
• NCL case study (1): Brian’s Low-Calorie Diet journey
• NCL case study (2): Sarah’s Low-Calorie Diet journey
• The NHS Low-Calorie Diet Programme video (short version)
• The NHS Low-Calorie Diet Programme video (long version).

Eligibility Criteria

Inclusions

• aged 18-65
• diagnosed with type 2 diabetes within the last six years
• BMI of 27kg/m2 or higher (adjusted to 25kg/m2 or higher in Black, Asian and Minority Ethnic (BAME) people)
  • a BMI obtained from self-measured weight is acceptable for referral; if this cannot be obtained, a clinic-measured value within the last 12 months may be used, provided there is no concern that weight may have reduced since last measured such that the individual would not be eligible for the programme at present.
• HbA1c measurement taken within the last 12 months, with values as follows:
  • if on diabetes medication, HbA1c 43 mmol/mol or higher
  • if not on diabetes medication, HbA1c 48 mmol/mol or higher
  • in all cases, HbA1c must be 87 mmol/mol or lower
  • if there is any concern that HbA1c may have changed since last measured, such that repeat testing may indicate that the individual would not be eligible for the programme at present, HbA1c should be rechecked before referral is considered.
• attended a monitoring and diabetes review when this was last offered, including retinal screening, and committed to continue attending annual reviews, even if remission is achieved.

Exclusions

• current insulin user
• pregnant or planning to become pregnant within the next six months
• currently breastfeeding
• has at least one of the following significant co-morbidities;
  • active cancer
  • heart attack or stroke in last six months
  • severe heart failure (defined as New York Heart Association grade 3 or 4)
  • severe renal impairment (most recent eGFR less than 30mls/min/1.73m2)
  • active liver disease (not including NAFLD)
  • active substance use disorder
  • active eating disorder
  • porphyria
  • known proliferative retinopathy that has not been treated.
• has weight loss of greater than five per cent body weight in the past six months, or is currently on a weight management programme
• has had, or is awaiting, bariatric surgery (unless willing to come off waiting list)
• health professional assessment that the person is unable to understand or meet the demands of the NHS Low-Calorie Diet Programme and/or monitoring requirements (due to physical or psychological conditions or co-morbidities).

How to Refer