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September 2020

Very low calorie diet on NHS for overweight T2D patients

The NHS has expanded a programme to provide a low calorie diet treatment for people who are overweight and have type 2 diabetes (T2D).

The programme is based on two large studies that showed that with a very low calorie diet, people with T2D who were overweight could improve their diabetes control, reduce diabetes-related medication and even achieve remission.


Eligible participants will be offered low calorie, total diet replacement products including soups and shakes consisting of 800 calories a day for up to 12 weeks. During this time participants will be expected to replace all normal meals with these products.

Alongside this, participants will receive support for 12 months including help to re-introduce food after the initial 12-week period. Depending on where the service is being delivered, this will either be group* based, one-to-one*, or digitally/ remotely via an app, online or over the phone.

This support will provide participants with the help and advice they need throughout every stage of the programme.

NHS England says participants will also be closely supported by their local GP practice – for example if medication needs to be changed.

Eligible patients must be aged 18–65 years, have a diagnosis of T2D within the last 6 years, and have a BMI over 27 kg/m2 (or over 25 kg/m2 in people of Black, Asian or minority ethnic origin).


The Diabetes UK-funded ‘DiRECT’ trial saw almost half of those with T2D who went on a low calorie diet achieve remission after one year. A quarter of participants achieved a 15kg or more weight loss, and of these, 86% put their T2D into remission.

A more recent trial of low calorie diets, called ‘DROPLET’, has demonstrated similar weight loss in people who were obese.

A study published last month in the journal Diabetologia showed that the approach is cost-effective: although total healthcare costs increased by about £600 in the first 2 years, over a lifetime it is expected to save more than £1,300 per individual.

Both obesity and diabetes are associated with increased risk of complications from COVID-19. Professor Jonathan Valabhji, NHS national clinical director for diabetes and obesity, said: ‘There has never been a more important time to lose weight and put their type 2 diabetes into remission.’

*Delivered online while social distancing guidelines are in place

Practice Nurse 2020;50(7):8