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December 2018

NHS to offer radical weight loss programme to patients with type 2 diabetes

Thousands of people with type 2 diabetes (T2D) will be offered a very low calorie diet in a bid to reverse their diagnosis under plans announced by NHS England Chief Executive Simon Stevens.

As reported in Practice Nurse earlier this year, very low calorie diets have been shown to put T2D in remission. Now Stevens has announced that very low calorie diets would be piloted ‘at scale’ from next year in patients recently diagnosed with the condition as part of the NHS long term plan, which will increase the focus on prevention as well as treatment.

Patients will be prescribed a liquid diet of just over 800 calories a day for three months and then a period of follow up support to help achieve remission of their T2D.

This approach will initially be piloted in up to 5,000 people following the Diabetes UK-funded DiRECT trial, where almost half of those who went on a very low calorie diet achieved remission of their T2D after one year. A quarter of participants achieved weight loss of 15kg or more, and of these, 86% put their type 2 diabetes into remission.

A more recent trial of very low calorie diets, DROPLET, has demonstrated similar weight loss in obese individuals.

The NHS Diabetes Prevention Programme is also to be scaled up, after it proved to be more successful than anticipated in helping people to achieve a healthy weight and increase levels of physical activity. It will also include online versions, involving wearable technologies and apps, to help people at risk of T2D who find it difficult to attend sessions.

NHS England said the moves would ‘not only improve the health of patients but also save the NHS money that can be reinvested in frontline care’. Currently, the health service in England spends around 10% of its budget on treating diabetes.

Around nine out of 10 people with diabetes have T2D, closely linked to obesity that can lead to a string of serious illnesses, including 13 types of cancer.

Recent projections also show that the growing number of people with diabetes could result in nearly 39,000 people living with diabetes suffering a heart attack in 2035 and over 50,000 people suffering a stroke.

Catch up now: Curing type 2 diabetes? The DiRECT study and its potential impact on primary care. Practice Nurse 2018;48(2):16–19.