The NHS Type 2 Diabetes Path to Remission Programme (T2DR, formerly the NHS Low-Calorie Diet Programme) is an evidence-based intervention programme that uses Total Diet Replacement (TDR) to support people recently diagnosed with type 2 diabetes to achieve significant weight loss (>15kg) and potentially attain diabetes remission (non-diabetic HbA1c results, at least six months apart, off all glucose-lowering medicines). There is no cost to participants, with all TDR (usually shakes) products funded by the NHS.

The programme allows participants to choose their preferred delivery model of either digital or in-person support. For the digital pathway, participants will not need to travel to a specific location for appointments. 

Participants will be matched with their own personal clinician to provide expert healthcare with tailored support throughout every stage of the programme. Oviva accepts motivated participants following a thorough eligibility check.

The intervention includes:

• 12 weeks of TDR, using four nutritionally complete meal replacement products
• four weeks of food reintroduction
• eight months of maintenance
• a refocus phase if required (if participants gain >2kg they have the opportunity to access additional dietetic support and follow the TDR for an additional four weeks).

See Videos to watch Oviva's programme training videos (including medication adjustments), view Oviva's range of resources under Downloads, and visit Oviva's healthcare professional and patient webpages under Resources.  

Oviva runs a monthly drop-in session for healthcare professionals at 1pm on the second Tuesday of each month. This can be accessed via MS Teams.

Digital app

Individuals with a smartphone can access Oviva's NHS-approved app to track their progress, as well as to communicate with their dietitian or coach and work their way through the programme.

All participants have access to the Oviva Learn educational platform, where new learning modules and resources are unlocked on a weekly basis. Oviva Learn aims to empower participants to engage and aims to facilitate learning about weight management in order to make impactful long term lifestyle changes.

Oviva Learn is accessible via the Oviva app, or participants can log in using their desktop computer or laptop. Those unable to access the online content will receive a printed guidebook.

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 primary care network (PCN) level in order 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 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.

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