Overview
The T2DR may be considered best suited to newly diagnosed diabetics or those with simple treatment regimens.
The T2DR can possibly achieve more than 50% of patients with a HbA1c < 48 if appropriate motivated patients are referred (this is very important because the patient is being asked to forgo food for 3 months and take supplements, before later reintroducing food).
This is possible because the patients can continue on some diabetes meds and, in Coventry and Warwickshire, one of the medications that patients are able to continue on if indicated are GLP1s which again will enhance weight loss and weight loss is the greatest predictor of type 2 diabetes remission.
If the patient is on <=2 meds then they can stop all T2D medications but if on more than 2 medications they can continue with 1 or more medications with guidance. In the T2DR programme if the patient is on blood pressure medication then s/he stops the last class of medication subject to guidance.
About the NHS Type 2 Diabetes Path to Remission (T2DR) Programme
The NHS Type 2 Diabetes Path to Remission (T2DR) Programme (formerly known as the NHS Low Calorie Diet) provides patient choice of an in-person or digital coached one-to-one service over 12 months, including 12 weeks of 800-900 kcal/day formula diet
The NHS T2DR service (formerly called the NHS Low Calorie Diet programme) aims to promote weight loss in patients that are overweight and recently diagnosed with Type 2 diabetes, achieving remission when possible
T2DR Programme is:
- Commissioned as part of a framework, a contract that is now national across England, by NHSE and the C&W ICB
- A lifestyle intervention which offers eligible patients a low calorie, total dietary replacement (TDR) products for 12 weeks, with a choice of soups and shakes
- This is followed by food reintroduction support for 6 weeks, and weight maintenance support for a further 34 weeks (total programme length 12 months)
- Some support with information and resources will be available after completing the programme
The full NHSE service specification can be found here: https://www.england.nhs.uk/long-read/nhs-type-2-diabetes-path-to-remission-programme-service-specification-2023/
T2DR is delivered by Momenta
Details of practice incentives are detailed in the commissioning document listed with the referral forms on the right, but this will only be visible to users with a login
EMIS searches for suitable patients
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Automated searches provided by the T2DR programme provider, Momenta, are now available on GP Gateway (link below). See user guide right.
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Patients may also be identified via opportunistic engagements
There is a referral form that is automatically populated with patient identifier details but requires information about diabetes and antihypertensive medications to be stated. Various details relating to the patient’s type 2 diabetes are also required such as date of diagnosis, recent HbA1c and BMI.
Downloading the EMIS XML file:
Within TeamNet link here, click to download the attachment called ‘BNSSG T2 Diabetes Remission Programme_V2_Jul_23’
This will download an XML file to your downloads folder. You can leave this here or cut and paste it to another safe location that you can find again later.
Please note: You do not need to open the XML file.
The file will not work until it is imported into EMIS Web.
See user guide for instructions how to import to EMIS.
Referral Process
Referrals can be made by health care professionals including:
- GPs
- Nurses
- Pharmacists
- Dietitians
- Other approved individuals
Clinical responsibility remains with the patient’s GP and medications adjustment guidance must be signed off by an appropriate professional
Eligibility Criteria
Actions required by referring practitioner BEFORE referral:
- Review the patient in a telephone appointment or in person, to support completion of this Referral and Medication Adjustment form for all patients
- Discuss likely medication changes with the patient
- Instruct them NOT to make changes immediately and to adjust their medications only on the day they start the meal replacements (TDR products)
Referral:
Please use the referral forms below (EMIS and blank forms attached)
There is also a choice of full or abbreviated forms
T2DR Referral Form Blank (Full with flowchart)
T2DR Referral Form EMIS (Full with flowchart)
T2DR Referral Form Blank (Abbreviated No Flow Chart)
T2DR Referral Form EMIS (Abbreviated No Flow Chart)
- Please give the patient a digital or paper copy of the Medications Adjustment form – even if the patient is NOT taking any relevant medications
- Please use secure NHSmail to send the completed Referral and Medication Adjustment Form or any questions to Momenta (the provider) at momenta.t2dr-cw@nhs.net
Please code as ‘Referral to total diet replacement programme’ – SNOMED 1239571000000105
For more information about the programme please direct patients to:
Email www.momentanewcastle.com/t2dr-cw
Phone patients can call the Momenta Adviser team on 024 7710 2217.
QR code link to participant webpage, including downloadable patient leaflet:
Contact:
If you have any questions you can also call 0330 056 2457.
Further information and referrer and patient resources including videos, guidance and leaflets are available here: www.momentanewcastle.com/hcp-t2dr-cw
Medication changes
The flowchart overleaf summarises the medications deprescribing – it is not intended to be comprehensive. The complete NHS England medications adjustment guidelines (including restarting agents) is here: www.momentanewcastle.com/hcp-t2dr-cw
For review soon
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Coventry
Rugby & South Warwickshire
North Warwickshire
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