A major study into the NHS ‘soups and shakes’ programme has given researchers and commissioners hope that type 2 diabetes remission can be achieved through at-scale intervention.
Published today in The Lancet Diabetes & Endocrinology, the study assessed remission of type 2 diabetes for real-world NHS participants, finding that of those who completed the programme and were measured twice, one-in-three (32%) had put their type 2 diabetes into remission.
The programme, a joint initiative between NHS England and Diabetes UK and which saw patients referred by their GP, was expanded to cover the whole of England this year. It provides a total diet replacement treatment for those living with type 2 diabetes and obesity, including soups and shakes.
It is the first study to show that remission of type 2 diabetes can be achieved through at-scale delivery outside of a research setting.
The research assessed data from the first 7,540 people referred into the programme.
The researchers said: ‘Our findings show that the mean weight loss for those who undertook the programme, whether or not they completed it, was 8.3% or 9.4 kg, increasing to 9.3% or 10.3 kg for the subgroup who completed the programme.
‘For those with two HbA1c measurements recorded at the applicable timepoints, 27% of participants who undertook the programme and 32% of the subgroup who completed the programme had remission of type 2 diabetes at 12 months, showing that people with type 2 diabetes can reach remission with this approach outside of research settings.’
Higher remission rates were associated with greater weight loss, according to the study, and logistic regression analysis showed that participants referred more than one year after diagnosis were less likely to have remission compared with those who were referred within one year of diagnosis.
How the programme works
Patients can benefit from the programme if they have been diagnosed with type 2 diabetes in the last six years, with referrals made by GP practice. The programme is offered to people who meet a set of criteria, which include those who:
- Are aged 18 – 65 years,
- have a diagnosis of type 2 diabetes within the last six 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)
Over 25,000 people have already been offered the programme since it was first piloted by NHS England in 2020.
Source: NHS England
NHS England said that the study suggests that the recent expansion of the programme to cover all of England ‘has the potential to benefit thousands more people’.
NHS England’s clinical director for diabetes and obesity Dr Clare Hambling said that the programme ‘can have a huge impact on the lives of participants’.
She said: ‘It’s brilliant that these findings show a large number of those who completed it have seen life-changing benefits including major weight loss and type 2 diabetes remission.
‘We know obesity is one of the biggest threats to health in the UK and will be one of the biggest and most costly challenges for health systems globally, so seeing such encouraging outcomes from our programme shows that obesity can be tackled head-on, and we’re looking forward to scoping any further expansion to this programme in due course.’
The programme was initially launched at 10 sites in 2020, reaching 5,000 patients, expanded to a further 11 areas in 2022 and doubled to cover the whole of England this year.
Previous data had already shown that the programme could work successfully to support weight loss, with participants typically losing 7.2kg (over one stone) on average after one month.
Oxford University associate professor of diet and obesity Dr Nerys Astbury said that the results of the new study re-enforce the findings reported previously in clinical trials.
Dr Astbury said: ‘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.’
She added that the remission rate is lower than reported in the Diabetes Remission Clinical Trial, which is ‘typically expected’ when programmes are translated from research into practice.
‘But for those who complete the programme, average weight loss after one year is similar to that reported in DiRECT and DROPLET2 trials,’ Dr Astbury said.
‘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.’
Professor Calum Sutherland, an expert in type 2 diabetes at the University of Dundee’s School of Medicine, said that there is ‘strong evidence’ that even a few years of remission greatly improves the long term health outlook for patients.
He said: ‘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.’
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