Key Points

• There is strong evidence demonstrating the effectiveness of weight management based diabetes remission programmes, for example, the Diabetes REmission Clinical Trial (DiRECT). Almost half (46%) the participants with Type 2 Diabetes (T2D) who completed an in-person weight management programme were in remission one year later, and 36% were in remission at two years. Recent long-term results show that 23% of participants continue to be in remission at five years with an average weight loss of 8.9 kg.
• We found no published evidence on the relative effectiveness of digitally delivered remission programmes compared with in-person, face-to-face diabetes remission programmes. We found no published economic studies assessing the cost effectiveness of digital remission programmes. There is evidence from a nationally implemented diabetes prevention (as opposed to remission) programme in England that people using a digital intervention achieved greater levels of weight loss than those using either remote or group-based, face-to-face interventions.
• Interim results from predominantly remotely delivered remission programmes in England and Wales suggest that participants have been able to achieve levels of remission and weight loss comparable to those observed in DiRECT.
• An economic evaluation based on the DiRECT study found that he total intervention cost was £1,411 per person. Whilst immediate intervention costs were only partially offset in the short-term, the longer-term benefits of being in remission led to average cost savings to the NHS of £1,337 per person over their lifetime. Longer-term savings accrued from a reduction in medication and need for diabetes-related healthcare with the intervention predicted to be cost saving within six years. Break even analysis found that at levels of remission and relapse observed in the trial, the total intervention cost would need to be in excess of £2,964 per person to cease being cost saving.
• A comprehensive cost analysis based on registry data for T2D patients in Scotland estimated that on average, diabetes patients used between £2,500 and £6,900 of healthcare resources per year, depending on their risk of developing cardiovascular disease. These figures illustrate the value of a remission programme in terms of the potential reduction in healthcare expenditure arising from diabetes-related complications and comorbidity.

What were we asked to look at?

We were asked to assess the evidence for a digitally delivered T2D remission programme. The programme is a weight management intervention comprised of a total diet replacement plan and longer-term support for weight-loss maintenance. A digital delivery model involves the use of videoconferencing and online self-monitoring tools alongside the remote provision of meal replacements; there are no in-person appointments with health professionals unless patients require intervention for other reasons.

Why is this important

Type 2 diabetes occurs in approximately 88% of all patients with diabetes nationally. Reducing risk factors for developing T2D, and remission of the condition are key indicators in the Scottish Government’s T2D prevention, early detection and intervention framework. There is a strong evidence base linking weight reduction with T2D remission. Dietary change based weight management programmes appear to be a scalable and relatively low-cost intervention that can be delivered both remotely and in community healthcare settings. The potential avoidance of diabetes related complications as a result of disease remission can significantly improve outcomes and quality of life for individuals living with T2D.

Referred by

The Accelerated National Innovation Adoption (ANIA) Collaborative.