Type 2 Path to Remission Programme

Overview

The NHS Type 2 Diabetes Path to Remission Programme is an evidence-based 12 month intervention using Total Diet Replacement (TDR) to support people recently diagnosed with Type 2 diabetes to achieve significant weight loss and potentially reduce medication use and attain remission of Type 2 diabetes. There is no cost to participants. 

The 12-month programme is now provided by Momenta Newcastle.   Patients can choose either in-person or digital support. The programme provides a 12 week low calorie diet treatment (typically soups, shakes and porridges), followed by reintroducing real food over 6 weeks and ongoing healthy eating, physical activity and behaviour change support to 12 months.  

Supporting information

Further details including EMIS resources, training videos, detailed required medication adjustment guidelines and patient and practice resources are available on the TeamNet page.

Eligibility

Inclusion Criteria

• Aged 18 - 65 years
• Diagnosed with Type 2 diabetes within last 6 years
• BMI ≥ 27kg/m² (adjusted to ≥25kg/m² for people of Black, Asian, and Minority Ethnic (BAME) ethnic origin)
• A HbA1c measurement taken within the last 12 months, with values as follows:
  • With diabetes medication, HbA1c >=43 mmol/mol
  • Without diabetes medication, HbA1c >=48 mmol/mol
  In all cases, HbA1c must be <=87 mmol/mol
• Have attended a monitoring and diabetes review when this was last offered, including retinal screening, and commit to continue attending annual reviews, even if remission is achieved. (If newly diagnosed then there is no requirement to wait for retinal screening to take place before offering referral)

Exclusion Criteria

• Current insulin user
• Currently breastfeeding
• Pregnant or planning to become pregnant during next 6 months
• Has one of the following significant co-morbidities:
  • Active cancer
  • Heart attack or stroke in last 6 months
  • Severe heart failure (defined as New York Heart Association grade 3 or 4)
  • Severe renal impairment (most recent eGFR < 30mls/min/1.73m²)
  • Active liver disease (not including MLD i.e. MLD is not an exclusion criterion);
  • Active substance use disorder
  • Active eating disorder (including binge eating disorder);
  • Porphyria
  • Known proliferative retinopathy that has not been treated (this does not exclude individuals who are newly diagnosed and have not yet had the opportunity for retinal screening)

• Has had bariatric surgery
• Health professional assessment that the person is unable to understand or meet the demands of the T2DR programme and/or monitoring requirements; or for whom the programme is not clinically appropriate (consulting with relevant specialist teams for patients with relevant conditions); or for whom safe and robust medications adjustment is not practical in a primary care setting.

Responsibilities

Responsibilities of the referring GP practice

Before referral:

• Provide information on concept of remission of Type 2 Diabetes, the service and potential risks and benefits to obtain informed consent
• Discuss medication changes to take place on the first day of T2DR and provide written confirmation of these change to the patient and Provider. Respond to any clinical need to further adjust medications according to capillary blood glucose and blood pressure monitoring by the Provider

Review:

• Arrange review of patient at 6 months and 12 months after starting the programme with repeat HbA1c –with further medication adjustment as necessary

Responsibilities of Momenta (Service Provider):

• Attempt to contact patients within 5 working days of referral to provide further information about the service, confirm eligibility and book an Individual Assessment
• Ensure the referred patient is aware of the medication changes advised by their GP practice (or that no medication changes are required) and reconfirm prior to the first day of TDR
• Deliver the 12-month service in the patient’s preferred pathway
• Perform / arrange for monitoring of capillary blood glucose and blood pressure (in people taking BP-lowering medications at time of referral) and, where outside of specified parameters, communicate appropriately with GP practice for further action.

Referral

Referrals to this service must be sent on the referral form which is available in EMIS and emailed to: momenta.t2dr-bnssg@nhs.net

Please be aware that the referral form includes questions on consent and details of changes to current medications so should be completed in part by the GP.

The EMIS referral form adds the following code to the patient’s record: 192931000006108 – Referral to total diet replacement programme

Contacts

Key contacts

• Patient Support Team: 0117 203 2117
• Referrer website - Information for GPs and practice staff: https://momentanewcastle.com/hcp-t2dr-bnssg
• Patient information page : https://momentanewcastle.com/t2dr-bnssg

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.