The NHS Type 2 Diabetes Path to Remission Programme offers a 12-month intervention using Total Diet Replacement (TDR) to achieve significant weight loss and potential diabetes remission. Participants receive personalised support from clinicians, access to digital and in-person pathways, progress tracking via an NHS-approved app, and educational resources through the Oviva Learn platform.

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 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 (if the patient is newly diagnosed with diabetes, reviews such as eye screening do not need to have taken place before making a referral to the programme). 

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 non-alcoholic fatty liver disease)
  • active substance use disorder
  • active eating disorder
  • porphyria
  • known proliferative retinopathy that has not been treated
• 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 T2DR Programme and/or monitoring requirements (due to physical or psychological conditions or co-morbidities).

How to Refer

Referrals must be completed by prescribing clinicians.