August 5, 2024

expert reaction to NHS soups & shakes diet and type 2 diabetes remission

Findings published in The Lancet Diabetes & Endocrinology looks at the NHS soups and shakes diet for diabetes remission.

Dr Dimitrios Koutoukidis, Senior Researcher in the Nuffield Department of Primary Care Health Sciences, University of Oxford, said:

“These are impressive real-world results showing that a third of people who start the NHS Type 2 Diabetes Path to Remission programme put their diabetes into remission. This means that they don’t need to take medication to control their blood sugar levels.

“The weight loss reported here is similar to the weight loss reported in controlled research studies, showing that the programme is an effective way to achieve substantial weight loss in the real world.

“There are 2 key differences between the NHS Type 2 Diabetes Path to Remission programme and other forms of restrictive dieting. Firstly, people don’t try to lose weight on their own but receive support to help them succeed. Secondly, the soups and shakes used in the programme are regulated to ensure they are safe and nutritious.

“These results can encourage clinicians to continue referring people to a programme that is effective. Additionally, people with type 2 diabetes might consider this programme as a good option for achieving diabetes remission.”

Prof Calum Sutherland, an expert in type 2 diabetes at the University of Dundee’s School of Medicine, said,

“The work by Dr Valhabji and colleagues represents a significant step forward in our fight to reduce the chronic health problems that develop in people living with type 2 diabetes.

“Their work confirms that the NHS can deliver diet replacement therapy for diabetes remission (T2DR) to large numbers of people diagnosed with type 2 diabetes in the last six years. This programme significantly reduces weight, improves glucose control and removes the need for medications in 1 in 3 of those who complete the programme, within 12 months.

“Those that lose most weight get the greatest health benefits. While this number is less than achieved in the smaller clinical trials that preceded this work, it still represents the most impressive level of remission of type 2 diabetes seen by any health intervention in the general population.

“There are well-established health benefits associated with all of these outcomes, including lowering risk of chronic kidney and heart disease, and should therefore greatly improve the quality of life of the patients. It will also benefit the NHS as costs required to generate this level of diabetes remission will be much lower than current costs to treat the health problems that develop in almost everyone with type 2 diabetes over time (it currently requires around 10% of the entire NHS budget to manage diabetes).

“While continued monitoring of these individuals is vital to ensure their diabetes does not return, there is strong evidence that even a few years of remission greatly improves the long term health outlook for these individuals.

“A T2DR programme is running in NHS Tayside and early indications are that very similar results are being found in Tayside, prompting the Scottish government to consider a Scotland-wide roll-out of the programme.”

Dr Nerys Astbury, Associate Professor Diet & Obesity at the University of Oxford, said:

“These new results demonstrate, replicate and re-enforce the findings reported previously in clinical trials, that using low-energy total diet replacement programme (TDR), delivered in the community can help people lose a significant and substantial amount of weight, and in some people, this can help put their type 2 diabetes into remission.

“These new findings show that the trial results can be achieved in routine care and at-scale in the NHS. The remission rate is lower than reported in the Diabetes Remission Clinical Trial (DiRECT)¹, which is typically expected when programmes are translated from research into practice. But for those who complete the programme, average weight loss after 1 year is similar to that reported in DiRECT and DROPLET² trials.

“People aged 18-65 years who have been living with type 2 diabetes for less than 6 years and have a BMI over 27 kg/m2 (where individuals are from White ethnic groups) or over 25 kg/m2 (where individuals are from Black, Asian and other ethnic groups) can be referred to the NHS England Type 2 Diabetes Path to Remission by their GP.

“We don’t know how long the remission will last, or how achieving remission can affect the risk of developing diabetes in the future. But we do know that losing weight has huge health benefits in all groups, particularly people living with type 2 diabetes. It lowers your blood glucose levels, reduces your blood pressure and your cholesterol levels, all of which will reduce your risk of developing the complications associated with diabetes. The longer people can be at lower body weight, the better their long-term health outcomes. These new findings show how rapidly implementing the findings of research into routine healthcare practice can achieve genuine and tangible patient health benefits.”

¹ https://doi.org/10.1016/S0140-6736(17)33102-1

² https://doi.org/10.1136/bmj.k3760

‘Early findings from the NHS Type 2 Diabetes Path to Remission Programme: a prospective evaluation of real-world implementation’ by Jonathan Valabhji et al. was published in The Lancet Diabetes & Endocrinology at 23.30 UK time on Monday 5 August 2024.

DOI: https://doi.org/10.1016/S2213-8587(24)00194-3

Declared interests

Nerys Astbury: Co-investigator on DROPLET trial. (TDR for weight loss in primary care funded by research grant from Cambridge Wight Plan UK Ltd to University of Oxford)

Calum Sutherland sits on the Executive Board of the Scottish National Diabetes prevention and remission framework and has asked Dr Valhabji to sit on an advisory board for some of its diabetes prevention work, which is not funded yet.

Dimitrios Koutoukidis:

• Working relationship with 4 of the authors:
  • Affiliated with the research team led by Susan Jebb and Paul Aveyard. Line managed by Susan Jebb.
  • Recently worked on a different research study with Jonathan Valabhji (first author) and Emma Barron.
• I am investigator in two investigator-led publicly funded (NIHR) trials of total diet replacement for treating non-alcoholic fatty disease where the weight loss intervention (total diet replacement) was donated by Nestle Health Sciences and Oviva to the University of Oxford.