Implementing type 2 diabetes remission interventions in the real world: what have we learnt?

Type 2 diabetes has long been considered a progressive condition requiring long-term treatment for maintaining glycaemic control. This notion, however, has been challenged by evidence from intensive weight management interventions such as bariatric surgery and very low-calorie diets. 1 Sjostrom L Peltonen M Jacobson P et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014; 311: 2297-2304 Crossref PubMed Scopus (799) Google Scholar , 2 Astbury NM Aveyard P Nickless A et al. Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial. BMJ. 2018; 362: k3760 Crossref PubMed Scopus (94) Google Scholar , 3 Lean ME Leslie WS Barnes AC et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018; 391: 541-551 Summary Full Text Full Text PDF PubMed Scopus (1252) Google Scholar Studies in individuals with type 2 diabetes undergoing these interventions have shown that type 2 diabetes remission is indeed possible through substantial reductions (>15–20%) in bodyweight. The Diabetes Remission Clinical Trial (DiRECT) 3 Lean ME Leslie WS Barnes AC et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018; 391: 541-551 Summary Full Text Full Text PDF PubMed Scopus (1252) Google Scholar was a landmark study that demonstrated that type 2 diabetes remission can be reached in primary care settings through total diet replacement (TDR) and behavioural change. Subsequent studies provided confirmation that substantial weight loss (DROPLET) 2 Astbury NM Aveyard P Nickless A et al. Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial. BMJ. 2018; 362: k3760 Crossref PubMed Scopus (94) Google Scholar and diabetes remission (DIADEM-1) 4 Taheri S Zaghloul H Chagoury O et al. Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol. 2020; 8: 477-489 Summary Full Text Full Text PDF PubMed Scopus (190) Google Scholar were possible through TDR. The success of these interventions prompted the National Health Service (NHS) in England to embark on an accelerated implementation programme aimed at delivering TDR interventions for people with type 2 diabetes. 5 NHS EnglandNHS Type 2 Diabetes Path to Remission Programme. https://www.england.nhs.uk/diabetes/treatment-care/diabetes-remission/Date accessed: July 19, 2024 Google Scholar In The Lancet Diabetes & Endocrinology, Jonathan Valabhji and colleagues 6 Valabhji J Gorton T Barron E et al. Early findings from the NHS Type 2 Diabetes Path to Remission Programme: a prospective evaluation of real-world implementation. Lancet Diabetes Endocrinol. 2024; (published online Aug 5.)https://doi.org/10.1016/S2213-8587(24)00194-3 Summary Full Text Full Text PDF Google Scholar present the initial findings from the real-world implementation of the NHS Path to Type 2 Diabetes Remission programme. Of the initial 7540 people referred to the programme, 4340 started TDR. 1740 participants had a full 12-month opportunity to undertake the programme, of whom 960 (55%) completed it. Remission status and HbA1c change were assessed for a subgroup of 710 participants who had started TDR before January, 2022, and had two HbA1c measurements recorded. 190 met the definition of remission (both HbA1c measurements <48 mmol/mol and no diabetes medication prescribed), with a mean weight loss of 13·4% and a mean HbA1c change of –12·6 mmol/mol. Those reaching remission were more likely to be within 1 year of diagnosis, to have had greater weight loss, and to have had lower HbA1c at baseline. Early findings from the NHS Type 2 Diabetes Path to Remission Programme: a prospective evaluation of real-world implementationFindings from the NHS T2DR programme show that remission of type 2 diabetes is possible outside of research settings, through at-scale service delivery. However, the rate of remission achieved is lower and the ascertainment of data is more limited with implementation in the real world than in randomised controlled trial settings. Full-Text PDF Open Access