The NHS Type 2 Diabetes Pathway to Remission Programme is a 12-month programme to support people living with Type 2 diabetes to achieve weight loss and a healthier lifestyle. This will enable them to better control their blood sugar levels – reducing the need for diabetes- related medication and potentially achieving remission of their type 2 diabetes.

All participants will receive one-to-one support, and they can choose their preferred delivery model, either digital one-to-one or in-person one-to-one support.

Participants will also have access to the NHS approved Oviva app which will enable them to track their food and activity, blood glucose and blood pressure, communicate with their coach through secure app messaging, log mood and set and monitor goals. Throughout the programme the participant will have access to the Oviva Learn portal to facilitate self-led learning. Oviva Learn is accessible via the Oviva app or you can log into your account on your desktop computer or laptop. Those unable to access the online content will receive a printed guidebook.

Participants will have lifelong access to Oviva’s digital tools, to encourage sustaining behaviour change long term. Participants might find a structured programme beneficial to help them maintain or reset their journey. To facilitate this, participants are able to rejoin the programme 12 months following discharge.

Please note pre-referral criteria are applicable in this referral and referrals may be returned if this information is not contained within the referral form.

Referral Criteria

Individuals who satisfy all the following eligibility criteria may be referred to the service

• Aged 18 to 65 years (inclusive)
• Diagnosed with Type 2 diabetes within the last 6 years
• Is not a current insulin user
• BMI greater than or equal to 27kg/m² (adjusted to greater than or equal to 25kg/m² in people of black, Asian and minority ethnic origin)
• BMI obtained from self-measured weight is acceptable for referral. If this cannot be obtained, a clinic-measured value within the last 12 months may be used, provided there is no concern that weight may have reduced since last measured such that the individual would not be eligible for the T2DR programme at present
• HbA1c measurement taken within the last 12 months, in line with the following:
  • If on diabetes medication, HbA1c 43-87 mmol/mol
  • If not on diabetes medication, HbA1c 48-87 mmol/mol
  • If there is any concern that HbA1c may have changed since last measured, such that repeat testing may indicate that the individual would not be eligible for the T2DR programme at present, HbA1c should be rechecked before referral is considered

• Must have attended for monitoring and diabetes review when last offered, including retinal screening, and commit to continue attending annual reviews, even if remission is achieved (those newly diagnosed do not need to wait for retinal screening before they can be offered a referral)
• Is not currently pregnant or planning to become pregnant within the next 6 months
• Is not currently breastfeeding
• Does not have any of the following significant co-morbidities:
  • active cancer
  • heart attack or stroke in last 6 months
  • severe heart failure (defined as New York Heart Association grade 3 or 4)
  • severe renal impairment (most recent eGFR lower than 30mls/min/1.73m2)
  • active liver disease (NAFLD is not an exclusion criterion)
  • active substance use disorder
  • active eating disorder (includes binge eating disorder)
  • porphyria
  • known proliferative retinopathy that has not been treated

• Has not undergone bariatric surgery (those awaiting bariatric surgery are not excluded)
• Health professional assessment that the person is able to understand and meet the demands and monitoring requirements of the NHS T2DR Programme

Patients are eligible to be re-referred 12 months after their discharge, if they previously started the programme

Referral Instructions

Please email completed forms to ovivauk.t2dr@nhs.net

Referral Form

The consultation check list is to ensure the patient is eligible for this programme before discussing the programme in more detail.

T2DR diabetes remission Oviva referral form

GP Information

The programme is based on two trials (DIRECT and DROPLET) which showed that a programme including a specially formulated diet for 3 months followed by healthy lifestyle support resulted in around 10-15kg weight loss at 1 year. In the DIRECT trial, which focused on people with type 2 diabetes, almost half of participants achieved remission of diabetes and many more had improvements in blood glucose control and reduced use of diabetes-related medication.

Early results show that, on average, participants on the programme lose 10.9kg at 1 year. This is similar to the outcomes seen in the clinical trials and is encouraging for its potential to support remission of type 2 diabetes.

Further information of the programme is on web page for Healthcare Professionals

Evidence base and outcomes

5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study -February, 2024

A32 Early outcomes from the NHS Low Calorie Diet Programme for people with Type 2 diabetes - April, 2023

Patient Information

Patient information flyer

Patient information leaflet

Patient facing web page: T2DR patient facing web page

Patient facing information video: T2DR patient information video

Pathway Group

This guideline has been signed off on behalf of the NHS Devon.

Publication date: March 24