The Type Two Diabetes Pathway to Remission program is an evidence-based intervention using Total Diet Replacement (TDR) to support people recently diagnosed with Type 2 diabetes to achieve significant weight loss and potentially attain diabetes remission (non-diabetic HbA1c results, at least 6 months apart, off all glucose-lowering medicines). There is no cost to participants with all TDR (shakes, soups and bars) funded by the NHS.
Eligibility criteria:
• Aged 18 to 65 years;
• Diagnosed with Type 2 diabetes within the last 6 years;
• A BMI of 27kg/m² or higher in people from White ethnic groups, adjusted to 25kg/m² or higher in people from Black, Asian and
other ethnic groups.
• BMI obtained from self-measured weight by a Service User 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 from the referrer that the Service User’s
weight may have reduced since last measured such that the individual would not be eligible for the Service at present;
• A HbA1c measurement taken within the last 12 months, with values as follows:
⎯ If on diabetes medication, HbA1c 43 to 87 mmol/mol; or
⎯ If not on diabetes medication, HbA1c 48 to 87 mmol/mol;
⎯ provided there is no concern from the referrer that the Service User’s HbA1c may have changed since last measured
such that the individual would not be eligible for the Service at present; and
• Have attended for monitoring and diabetes review when this was last offered, including retinal screening, and commit to
continue attending annual reviews, even if remission is achieved. (For avoidance of doubt, if a Service User is newly diagnosed
then there is no requirement to wait for retinal screening to take place before offering referral)
• Individuals who meet any of the following exclusion criteria must not be referred to the Service and must not be accepted by the
Provider. The Provider must confirm that the individual is eligible and so does not meet any of the following exclusion criteria
prior to the individual’s commencement of the intervention:
Individuals must not be:
• Current insulin user;
• Pregnant or planning to become pregnant within the next 6 months;
• Currently breastfeeding;
• Discharged in the last 12 months from the NHS T2DR Programme after having commenced the programme (for clarity, this
does not apply to people previously referred to the programme but who dropped out or decline prior to commencing the TDR
Phase);
• Has at least 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 less than 30mls/min/1.73m20:
⎯ active liver disease other than non-alcoholic fatty liver disease (NAFLD) (i.e. NAFLD is not an exclusion criterion);
⎯ active substance use disorder;
⎯ active eating disorder (including binge eating disorder);
⎯ porphyria; or
⎯ 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; or
• 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).