Community-based pilot study of type 2 diabetes remission through weight loss achieved by total diet replacement based on direct trial

Aim: To deliver a person-centred intervention aiming to achieve significant weight loss and potential remission of type 2 diabetes in a real-world community setting, using a similar model to the DiRECT trial. The programme adapts a holistic multidisciplinary approach with a combination of nutrition, psychology and exercise education support for long-term behaviour change and self-management, as well as enabling system savings. Method: 23 patients (68% BAME, 53% male) with type 2 diabetes participated in the 24-week programme with final visit in December 2020. After initial assessment, participants underwent 12 weeks of total diet replacement (TDR) using 800 kilocalorie daily supplementation, followed by food reintroduction. Culturally sensitive diet and lifestyle support was provided by regular phone calls along with 26 e-learning modules. Results: Mean weight loss after TDR was 13.5 kg (range 5-29 kg) at week 24. 88% of patients at week 24 were not on medication. 81% on diabetic medication at baseline no longer required any diabetic medication;13% were prescribed a lower dose and 6% were still on the same dose. 36% were no longer prescribed any blood pressure medication. Mean HbA1c decreased by 14 mmol/mol at week 24 but was only available for 11 participants due to covid-19 pandemic. There was self-reported improvement in participants' quality of life. Conclusion: The pilot results are in line with findings from DiRECT. System-wide financial benefit was achieved through de-prescribing of diabetes medication. These results are being used to inform and deliver a TDR service as part of NHS England's type 2 diabetes remission programme.