What is it?

The 12-month NHS Type 2 Diabetes Path to Remission Programme (T2DR), formerly NHS Low Calorie Diet Programme (LCD), is delivered remotely by Liva and has three main phases:

Total Diet Replacement
(TDR) Phase

This is the total diet replacement stage, where all food will be replaced with 4 daily soups or shakes of up to 900 calories, for 12 weeks.

You will be supported by your group members and Health Coach throughout this key stage.

Food Reintroduction
Phase

In this phase, we’ll work alongside you to gradually re-introduce food over a period of 6 weeks. Here, you’ll start developing lifestyle changes that will support you for the long term.

No need to feel nervous in this stage – your Health Coach, group and programme of evidence-based learning will support you with the knowledge and tools needed, to re-introduce food in a way that sustains the health changes you have made.

Maintenance
Phase

In this stage, it’s all about continuing to sustain the healthy habits you are developing.

You’ll work with your group and your Health Coach to embed your lifestyle changes and continue to strategise around what realistically works for your unique lifestyle.

You may continue to lose weight during this stage, or you may look to maintain it. Your coach will support you with 
a personalised plan that works for you on an individualised level.

Who can join this programme?

The programme is completely free but you can only participate if you are referred by your GP practice and meet all of the inclusion criteria but none of the exclusion criteria below, subject to health professional assessment.

If you’re unsure if you meet these criteria, please discuss your eligibility with your GP.

Inclusion Criteria​

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  • Aged between 18-65
  • Diagnosed with Type 2 diabetes within the last 6 years
  • BMI of >=27 kg/m² in people from White ethnic groups (adjusted to >=25 kg/m² in people from Black, Asian and other ethnic groups)
  • Engaged with diabetes care: attended last diabetes monitoring review, including retinal screening (there is no need to wait for this if you are newly diagnosed)
  • Willing to commit to ongoing annual reviews, even if remission is achieved
  • HbA1c within the last 12 months that is within the following values:
    • 43-87 mmol/mol if on diabetes medication
    • 48-87 mmol/mol if not on diabetes medication
  • Be willing to commit to the entire 12 month programme
  • Willing to attend remote group sessions delivered over video conferencing
  • Registered with a GP practice in Lancashire & South Cumbria
  • Comfortable with just soups and shakes for the first 12 weeks
  • Have a smartphone or tablet, an email address, and are comfortable with using technology

Exclusive Criteria

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  • Current insulin user
  • Currently breastfeeding
  • Pregnant or planning to become pregnant within the next 6 months (Note: weight loss may cause previously lost fertility to return)
  • Have had bariatric surgery
  • Has one of the following comorbidities:
    • Active cancer
    • Heart attack or stroke within the last 6 months
    • Severe heart failure (grade 3 or 4)
    • Severe renal impairment (last eGFR <30 mls/min/1.73m²)
    • Active liver disease (excluding non-alcoholic fatty liver disease)
    • Active substance use disorder
    • Active eating disorder
    • Porphyria 
    • Untreated proliferative retinopathy (unless newly diagnosed and not yet screened)
  • Have had bariatric surgery
  • Health professional assessment that you are unable to understand or meet the demands of the NHS LCD Programme and/or monitoring requirements; or for whom the programme is not clinically appropriate; or for whom medication adjustment would not be appropriate

Inclusion Criteria​

  • Aged between 18-65
  • Diagnosed with Type 2 diabetes within the last 6 years
  • BMI of >=27 kg/m² in people from White ethnic groups (adjusted to >=25 kg/m² in people from Black, Asian and other ethnic groups)
  • Engaged with diabetes care: attended last diabetes monitoring review, including retinal screening (there is no need to wait for this if you are newly diagnosed)
  • Willing to commit to ongoing annual reviews, even if remission is achieved
  • HbA1c within the last 12 months that is within the following values:
    • 43-47 mmol/mol if on diabetes medication
    • 48-87 mmol/mol if not on diabetes medication
  • Be willing to commit to the entire 12 month programme
  • Willing to attend remote group sessions delivered over video conferencing
  • Registered with a GP practice in Lancashire & South Cumbria
  • Comfortable with just soups and shakes for the first 12 weeks
  • Have a smartphone or tablet, an email address, and are comfortable with using technology

Exclusion Criteria​

  • Current insulin user
  • Currently breastfeeding
  • Pregnant or planning to become pregnant within the next 6 months (Note: weight loss may cause previously lost fertility to return)
  • Have had bariatric surgery
  • Has one of the following comorbidities:
    • Active cancer
    • Heart attack or stroke within the last 6 months
    • Severe heart failure (grade 3 or 4)
    • Severe renal impairment (last eGFR <30 mls/min/1.73m²)
    • Active liver disease (excluding non-alcoholic fatty liver disease)
    • Active substance use disorder
    • Active eating disorder
    • Porphyria 
    • Untreated proliferative retinopathy (unless newly diagnosed and not yet screened)
  • Have had bariatric surgery
  • Health professional assessment that you are unable to understand or meet the demands of the NHS LCD Programme and/or monitoring requirements; or for whom the programme is not clinically appropriate; or for whom medication adjustment would not be appropriate

Note: A history of gallstones or biliary disease should be reviewed as these conditions can be exacerbated by rapid weight loss.

“I’ve lost around 4 stone. 
And I feel so much healthier”

Mandy
Member, NHS T2DR programme

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