What is the NHS Type 2 Diabetes Path to Remission Weight Loss Programme?

The NHS Type 2 Diabetes Path to Remission Programme is a low-calorie diet replacement treatment designed to help people with type 2 diabetes work towards remission.¹

Diabetes remission means your blood sugar levels return to a normal range for at least three months without needing glucose-lowering medication. In medical terms, this means having an HbA1c level below 48 mmol/mol.² By achieving diabetes remission, you can lower your risk of complications associated with type 2 diabetes like heart attacks, and strokes. ³

How does it work?

The program runs for 12 months and has three main stages. ¹ Throughout the journey, you’ll get support from a specialist team that may include your GP, dietitians, and other diabetes experts.¹ Not everyone is eligible, however. Things like where you live, your weight, BMI, and age will determine if the program is right for you. ¹ Your GP can provide more information about your suitability.

Stage 1: Total Diet Replacement (TDR)

During the first 12 weeks, participants replace all meals with total diet replacement products, such as soups, shakes and bars, which provide 800–900 kcal daily. ⁴

Participants are encouraged to stay well-hydrated, consuming 2.5 litres of sugar-free fluids daily, such as water, sugar-free diluting juice, zero-calorie sugar-free beverages, tea, or coffee. ⁵ Gentle exercises, like walking, are also recommended.⁵

To manage hunger and cravings, consider timing your meals carefully and planning distraction strategies, such as going for a walk, journaling, or calling a loved one. Your healthcare team can provide additional support.

A weight loss goal may be set during this phase, as losing weight improves insulin sensitivity and blood glucose control.⁶ Research suggests that individuals who lose around 15 kg (2 stone 3 pounds) during this stage are more likely to achieve diabetes remission.⁶

Stage 2: Reintroducing healthy meals

After completing the total diet replacement phase, you will gradually reintroduce healthy foods over six weeks, reducing reliance on meal replacement products.⁴

The healthcare team provides personalised advice, and meal plans to ensure the diet is balanced and supports weight loss.⁴ During this time, you may choose to explore some dietary approaches with your healthcare team, such as a partial meal replacement approach, a low-carbohydrate diet or the Mediterranean diet.

Stage 3: Weight maintenance

This is the longest stage of the program. By this point, many people have found that they have achieved significant weight loss and are starting to see its benefits such as increased energy or improvements in blood glucose control. ⁴

During this stage of the program, you may choose to continue losing weight or consider maintaining your weight loss. You will be supported with your chosen dietary approach, portion control, and how to build activity into your lifestyle.⁴ If you notice any weight regain during this time, you can speak to your healthcare team, who will be able to advise you.  

Feeling Hungry

Hunger can be tough, especially in the first few weeks of the total diet replacement stage. The good news is that it usually gets better as your body adjusts. Staying hydrated and keeping busy can help, and the protein in the shakes and soups (around 20 g per serving) can also help to make you feel fuller.⁷

Social Situations

Social events during the meal replacement phase can be tricky, especially if they revolve around food. You could try joining events after the meal, having your soup or shake beforehand, or even bringing it with you. Celebrating in non-food-related ways, like going to play mini-golf, going for a nice walk or having a spa day for an event, can also be fun to join in with the celebrations. Your healthcare team can help you figure out what works best for you.

Regaining weight

Maintaining weight loss can be challenging. Setting small, achievable goals and building healthy habits around food and exercise can make a big difference. If you need extra help, your healthcare team is there to support you.

Achieving diabetes remission

Research from the DIRECT study found that about 32% of people who completed the program (or one in three) achieved diabetes remission. ⁶

Not everyone will achieve diabetes remission, and factors such as age and how long you’ve had diabetes can play a role.⁸ But even for those who don’t, many find they’re on fewer medications, have lost weight, and feel much better overall.^9-10

References:

1. The National Health Service [Internet]. NHS Type 2 Diabetes Path to Remission Program [updated 2024 December 10; cited 2025 January 9] Available from https://www.england.nhs.uk/diabetes/treatment-care/diabetes-remission/

2. Riddle MC et al. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care. 2021; 64: 2359-2366.  

3. Diabetes UK [Internet]. What is type 2 diabetes remission. [ updated 2024 January 29; cited 2025 January 9] Available from: https://www.diabetes.org.uk/about-diabetes/type-2-diabetes/remission/what-is-type-2-diabetes-remission

4. Diabetes UK [Internet]. The remission weight loss program. [updated 2024 January 29; cited 2025 January 9] Available from https://www.diabetes.org.uk/about-diabetes/type-2-diabetes/remission/the-remission-weight-loss-programme  

5. Lean M et al. Feasibility and indicative results from a 12 month low-energy liquid diet treatment and maintenance programme for severe obesity. British Journal of General Practice. 2013; 63(607): e115-e124.  

6. Lean M et al. Primary care-led weight management for remission of type 2 diabetes (DIRECT): an open-label, cluster-randomized trail. The Lancet. 2018; 391(10120): 541-551.  

7. Paddon-Jones D et al. Protein weight management, and satiety. AM J Clin Nutr. 2008; 87(5): 1558S-1561S.  

8. Dambha-Miller H et al. Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study. PLos One. 2023; 18:8: e0290791.

9. Thom G, Messow CM et al. Predictors of type 2 diabetes remission in the Diabetes Remission Clinical Trail (DiRECT). Diabetic Medicine. 2020; 38(8).  

10. Edwards-Hampton SA and Ard J. The latest evidence and clinical guidelines for use of meal replacements in very-low-calorie diets or low-calorie diets for the treatment of obesity. A Journal Of Pharmacology and Therapeutics. 2024; 26(S4): 28-38.