New breakthrough NHS treatment can send type 2 diabetes into remission
Published on: 4th February 2020
From 1 February, the first patients in North West London will be able to benefit from REWIND, a new NHS programme, provided by ICS Health & Wellbeing. The aim of REWIND is to reduce medications, improve quality of life, and empower people with type 2 diabetes. It also has the potential to send a patient’s type 2 diabetes into remission. Residents of North West London are among the very first people in the country to have access to this new breakthrough service, which has been successfully trialled by NHS North West London Collaboration of CCGs (1).
During its trial period, all participants achieved a reduction in medication and 88% achieved an HbA1c of less than 48mmol/mol. The £5m investment will now go live and start benefitting patients next month. 15,000 people in North West London with type 2 diabetes will get access to the new programme.
The 12 month programme works by offering patients with type 2 diabetes intensive lifestyle support to self-manage their condition. The service offers blended nutrition, psychology and physical activity in group, one-to-one and online learning styles to achieve long term behaviour change. Over the course of a year, patients will be fully supported by GPs, practice nurses, health coaches, dieticians, exercise specialists and clinical psychologists as they improve their health, wellbeing, and overall quality of life.
How does it work?
The DiRECT (Diabetes REmission Clinical Trial) study in Newcastle and Glasgow, run by Professors Roy Taylor and Mike Lean showed (see notes to editor) that changing your diet and lifestyle can have a major positive impact on type 2 diabetes management. On the DiRECT study, 46% of type 2 diabetes patients who joined the programme saw their condition go into remission at one year.
REWIND takes this research and adapts it to make it culturally relevant for different learning styles. With REWIND, patients get professional support to change their lifestyle through a wide range of flexible resources, including online tools, in-person group sessions and one-to-ones throughout the year. Through this intervention, patients lose weight and are able to maintain this long term.
Research shows that patients that losing over 15kg offers a nearly 90% chance of reducing medication and achieving remission for type 2 diabetes - but even losing as little as 5kg can increase a patient’s energy level, reduce risk of heart disease, and improve mental wellbeing.
Who is it for?
Patients must be assessed by a GP before referring to the REWIND service.. Patients must be 18 years or older to be eligible, be diagnosed withtype 2 diabetes within the last twelve years, and be currently taking one of the following medicines: DPP-4, SGLT-2 or GLP-1. It is strongly advised that any major diet or weight loss plans are discussed carefully with a medical professional prior to referral.
After an assessment, the patient’s GP will recommend the most suitable option for their needs. The options are:
Total diet replacement: Twelve weeks of a very low-calorie diet of shakes and soups, followed by twelve weeks of gently reintroducing food into the diet, and then six months maintaining the new healthy eating lifestyle. This option is only advisable for patients eligible following an assessment by a GP.
The low carbohydrate choice: If patients are ineligible for total diet replacement, they can choose the low carbohydrate option. This option involves twelve weeks of ‘learning’ a new low carbohydrate diet followed by twelve weeks of incorporating what they have learned into their regular habits. The programme is successfully completed when the patient has kept this new lifestyle up for six months.
A patient on the REWIND pilot said:
“The ICS Diabetes Remission Programme has literally been a life saver for me and has improved the quality of my life beyond expectation.”
Another patient from Hammersmith and Fulham on the pilot said:
“I was diagnosed with Type 2 diabetes 7 years ago and struggled to make the changes I needed to make. I joined the total diet replacement programme and have lost 35kg over the first 3 months of the program and hope to be able to lose more as I continue with the program.
“Before the program I was taking 7 medications a day for my diabetes and associated blood pressure problems and now I no longer need to take any medication for diabetes and only one for blood pressure. I now have more energy and no longer feel as tired as I did.
“The team give you support to carry on and motivate you to see how the small changes you’re making now will a massive impact on your future health.”
GP and Clinical Director for Diabetes at NHS North West London Collaboration of CCGs, Dr Tony Willis, said:
“REWIND changes completely how we support patients with Type 2 diabetes. Most of my patients with Type 2 diabetes tell me that they would like to reduce their medication, and that they would like to lose weight. REWIND is proven to boost your chances of achieving both.
“It is important that any diets or weight loss plans are discussed carefully with a medical professional before you decide if they’re right for you.”
Clinical Dietetic Lead for ICS Health & Wellbeing, William Hadfield said:
“This ground-breaking programme now offers people living with Type 2 diabetes a new option. We no longer have to rely on medications to manage blood glucose levels – we give people the tools to take control and manage Type 2 diabetes in their own way. This is going to revolutionise the way we manage Type 2 diabetes.”
Professor of Medicine and Metabolism at Newcastle University and lead investigator of the DiRECT study, Roy Taylor, said:
“This is an exciting programme, which makes losing weight as easy as 1,2,3. We know now that Type 2 diabetes is a reversible condition, and REWIND will use the latest research to help many people improve their health and enjoy life more fully”.
NOTES TO EDITOR
- NHS North West London Collaboration of Clinical Commissioning Groups (CCGs) is made up of eight CCGs who work together to design, plan, and commission (buy) health services for the population of North West London. These eight CCGs are: Brent, Harrow, Hillingdon, Central London, West London, Hammersmith and Fulham, Hounslow and Ealing CCGs.
- There are nearly 150,000 people with type 2 diabetes in North West London. To begin with, 10% of these people (15,000) will get access to this new intensive support programme, with the first patients beginning their programme in February.
- The trial was funded by Diabetes UK and led by Professor Roy Taylor from Newcastle University and Professor Mike Lean from Glasgow. Both Diabetes UK and Professor Roy Taylor back this programme.
- Read more about primary care-led weight management for remission of type 2 diabetes (DiRECT) in The Lancet. Vol 391; 10120 (P541-551).
