NHS Type 2 Diabetes Path to Remission
FAQs

Our programme follows the latest research into Diabetes Remission, the DiRECT study and consists of 3 phases over 12 months.

During Phase 1, you will replace all your usual foods, and calorific drinks, with total diet replacement products of 8-900 calories a day which will allow you to lose weight relatively rapidly, safely under supervision. Most people can expect to lose between 10% – 15% of their body weight in the first 12 weeks.

Losing weight on the 8-900 calorie diet helps you to remove fat from your internal organs. Clearing this excess fat from your liver and pancreas helps them to work more efficiently again, which in turn helps to control your blood glucose levels and improve your health.

Phases 2 and 3 support you to learn how to develop and implement healthy lifestyle behaviours to maintain a lower body weight and stabilise your blood glucose levels, with the potential to put diabetes into remission.

On average most people lose between 10 and 15% of their body weight during Phase 1 on TDR. This is more than you can expect to lose using other safe dietary approaches.

There are a total of 21 sessions during the 12 month period, which are split into 3 phases to support your journey.

Whether you have chosen to meet with your coach in-person or digitally using MS Teams, you are expected to attend 21 sessions with your coach during the 12-month programme and engage with learning activities between sessions.

To get the most from this programme you need to be motivated to change your eating and exercising habits, able to attend regular appointments, keen to reduce or come off medications and prepared to commit fully to the programme for 12 months. Having support from family and friends will also help tremendously.

However, losing weight rapidly on an 800 calorie diet using meal replacements does not suit everyone.

If you’re unsure whether this programme is the right approach for you, you may find it helpful to complete our readiness questionnaire if you have not already done so and discuss other options with your GP or diabetes nurse.

Once you begin the programme, if you are discharged, you cannot be re-referred to start it again for 12 months from your discharge date.

Therefore, if you have any reservations over the timing of your start, you can ask to be discharged before commencing the programme and re-referred by your GP at any time.

There are a few common side effects that may arise from stopping medications, replacing usual food with TDR and rapid weight loss. This is because using TDR products to lose weight  is a more intensive strategy than most other food based weight loss diets.

Not everyone will experience side effects and the most common ones are preventable or easily managed by following the TDR prescription carefully, spacing TDR products at regular intervals and drinking enough fluid throughout the day.

The programme starts with weekly sessions to support you as you start TDR and then moves to fortnightly sessions. Sessions are monthly for the remaining 8 months of the programme as you form new healthy habits and become more confident and skilled in managing your health and wellbeing.

Please schedule all your appointments in your diary and prioritise attending these sessions especially as we have limited opportunity to reschedule appointments.

The earliest you can achieve remission is at the end of the programme if you have two HbA1C readings < 48mmol/mol at 6 months and 12 months after starting the programme.

You’ll achieve remission of type 2 diabetes when you are no longer taking any blood glucose lowering medication and have two consecutive HbA1c measurements that are less than 48mmol/mol, at least 6 months apart. HbA1c testing is done within your GP practice, so please contact them to arrange.

Your GP practice will give you a Medication Adjustment Form (MAF) with specific instructions about any changes you need to make to your medications on the day that you start the total diet replacement (TDR) products.

Please keep your MAF in a safe place for your reference

Please note that your MAF is specific to you and your health and medication needs. It is very important that you understand and follow the guidance on your MAF to keep safe during Phase 1 of the programme. This is because it is unsafe to take some diabetes medications on a low calorie diet and you could become very ill. 

If you are in any doubt about your prescribed medication adjustments, please contact your GP practice and DO NOT START the total diet replacement products until you are certain of the adjustments you have to make.

On average most people lose between 10 and 15% of their body weight during Phase 1 on TDR. This is more than you can expect to lose using other safe dietary approaches.

You’ll need to measure your weight and blood glucose at every session. You’ll be given your own blood glucose meter for use throughout the programme. You do not need to take blood glucose measurements outside of your sessions (you will run out of testing strips if you test more than you need to and will need to buy replacements from the manufacturer).

You will also need to measure your blood pressure if you’re on any medications that lower or affect your blood pressure. You will be informed before you start if we require you to take your blood pressure.

On the digital programme you will be expected to upload your measurements on the App ahead of every session with your coach. The App is easy to follow and you will be prompted to add your latest measurements. If you do not provide measurements, you will be at risk of discharge as we must monitor your safety on the programme. 

If you’re attending an in-person clinic you’ll need to have your measurements to give to your coach – as a minimum your blood glucose measurement as your Coach can support with other measurements if needed.

During phase one on TDR, you’ll be getting significantly fewer calories (energy) than you’ll be used to and feeling tired is quite normal. You should be able to continue doing any light-moderate exercise you have previously been doing such as walking or gentle swimming but it’s best not to increase your activity levels or do vigorous or lengthy exercise.

In Phase 2 you’ll be able to focus on making your day-to-day life more active. Increasing physical activity and exercise will help you keep your weight off and prevent you regaining weight when you start reintroducing food.

Not only that but it is brilliant for health and well-being and improves your chances of achieving remission by ‘oiling those rusty locks’ that stop insulin from working  – known as insulin resistance.