Real-world impact
The key real-world impact of this study was that it has informed the national roll-out of the NHS LCD programme, now renamed [with the assistance of the Re:Mission study patient and public involvement (PPI) group] the NHS Type 2 Diabetes Path to Remission Programme.
In addition to four of the research team members (Ells, Evans, Radley and Homer) supporting the national procurement process, the following extracts from the national NHS T2D Path to Remission service specification21 demonstrate the changes made as a direct result of the learning from this study:
- The provider must offer a variety of TDR products such as soups, shakes and other suitable products. These must include the availability of varied flavours and textures to support service user compliance and retention on the NHS LCD Programme.
- The provider must supply the appropriate TDR products to service users but must not supply any service user with more than a 4-week supply of TDR products at any one time.
- The provider must consider the needs of a variety of potential service users, including offering suitable or alternative TDR products where possible for those with intolerances (e.g. lactose intolerance) which may impact their ability to use certain products.
- It is intended that, within a defined geographical area, a single provider will deliver the NHS LCD Programme by offering to individuals the following choice of delivery models: 1 : 1 face-to-face (the ‘Face-to-Face Delivery Model’) or 1 : 1 digital support (the ‘Digital Delivery Model’).
- The provider must monitor service performance and inequalities in outcomes and take appropriate corrective action to improve performance and reduce inequalities accordingly. Specific attention should be given to monitoring and improving performance relating to people with characteristics which have been associated with poorer outcomes in the pilots.
- In addition to the exclusion criteria of anyone with an active eating disorder at referral, if the provider suspects or identifies behaviours that meet the threshold of an eating disorder, the GP practice should be notified, and the service user should be advised to seek care with their GP practice accordingly. In addition, identification of an active eating disorder should be recorded as an adverse event.
- Additional details were added to this statement: the provider must actively encourage and respond to service user feedback. This should be sought on all aspects of the service including the curriculum, programme structure, frequency of support, TDR products, coaching, approach to meeting individual, cultural adaptation, support materials and functionality/usability of any digital tools. The provider must have effective governance processes for collating and actioning such feedback as well as for responding to any complaints.
- Service users must be provided with adequate information about the delivery models to allow for an informed, unrestricted choice about which delivery model would better suit their needs and individual context.
- The provider must ensure that service users receive appropriate advice, tools and support in preparation for the FR phase and the transition to healthy eating. This includes healthy dietary plans appropriate to their preferences and culinary traditions.
- Advice and dietary plans should be tailored to the service users’ individual needs, preferences and culinary traditions.
- When the numbers of TDR, FR and WM sessions are described in the specification, the following statement should be added to encourage additional support: (or more frequently at the discretion of the provider).
- Service users should be made aware of the availability of peer support throughout the intervention. If the service user accepts the offer of peer support, this should be facilitated by the provider.
- Planned pauses: if otherwise at risk of disengagement from the programme due to life circumstances or external factors, a planned pause by a service user of up to 4 weeks can take place during any phase of the programme after the start of the TDR phase. Where a pause is arranged, the provider must share the details of the pause with the service user’s GP practice. If the service user is not able to restart the programme within 4 weeks of commencing the pause, the service user should be discharged. If, following discharge, the individual subsequently requests to restart the programme, the provider must inform the individual that they will need to be re-referred by their GP practice. If they had previously commenced the TDR phase of the programme, they should be informed that they will not be accepted on to the programme until a period of 12 months has elapsed since the date that individual was discharged. Where a service user restarts the programme within 4 weeks after an agreed planned pause, the calculation of that service user’s progression on the programme, the Milestone 2 Period and the Milestone 3 Period, must not take into account the period of the pause. For example, if a service user commences an agreed planned pause at the end of week 14 and the pause lasts 2 weeks, on restarting the programme, the service user should be treated as starting week 15 of the programme. Where a service user commences an agreed planned pause during a rescue package, the rescue package is treated as having ended on the commencement of the pause.
- The provider should be explicit regarding the behavioural change theory and techniques that are being used, and the expected mechanism of action of their intervention (RA3). The logic model (see Appendix 4) was also provided as a template for SPs and assessed in the latest procurement process.
Shared learning
As one of the largest real-world evaluations of a TDR-based LCD approach, learning has been shared internationally, nationally and locally, through the study website (www.remission.study), and presentations at the following events, in addition to the extensive PPI shared learning described below:
International
- European Congress on Obesity (Online) 2021
- The Association for the Study of Obesity Winter School Early Career Research Event 2022
- Royal Society for Public Health Key Note 2022
- UK Congress on Obesity (Lancaster) 2022
- European Congress on Obesity (Dublin) 2023
- European Association for the Study of Obesity Early Career workshop on PPIE 2023
- European Congress on Obesity (Venice) 2024.
National
- Podcast for Leeds Beckett University 2021
- Royal College of Physicians 2021
- Obesity UK Support Group 2021
- Association for the Study of Obesity Webinar 2021
- The UK Society of Behavioural Medicine Early Career Network 2021
- The British Psychological Society Division of Health Psychology Annual Conference 2022
- Self Employed Nutritionists’ Support and Enlightenment (Sense) Nutrition group 2022, 2023
- The Association for the Study of Obesity/UK Congress on Obesity Early Career Research Event, 2022
- The UK Society of Behavioural Medicine Annual Scientific Meeting 2023
- Diabetes UK Research Group 2023
- Association of British Clinical Diabetologists webinar (June) and conference (September) 2024
- UK Congress on Obesity, Oxford 2024.
Regional
- Yorkshire Obesity Research Alliance seminar 2021
- Active Lifestyles online cafe (Carnegie School of Sport) 2022
- Active Lifestyles Spring online conference (Carnegie School of Sport) 2023.
Local
- Teesside University researcher presentation 2021
- Carnegie School of Sport Active Lifestyles Cafe 2022
- Leeds Beckett University School of Health seminar 2022
- Leeds NHS Low Calorie Diet group meeting 2022
- Sheffield Hallam University Sport and Physical Activity Research Centre seminar series 2022
- Leeds Beckett University School of Sport postgraduate conference 2023.
This was in addition to: incorporation of learning in both undergraduate and Masters programmes across the schools of health and sport at Leeds Beckett University; a media campaign in April 2024 with the British Journal of Diabetes (BJD) to share learning and launch the BJD special edition for the Re:Mission service user experience papers; and launch of the Re:Mission study service user journey short film, and public-facing evaluation report – delivered through an illustrated online and print journal in April 2024.
Pre-planned activities
Additional upcoming pre-planned activities include:
- Shared learning at the Diabetes UK Conference 2025
- An application to undertake a symposium at the European Congress on Obesity 2025 (as the 2024 conference is not accepting member-led symposia due to venue restrictions)
- Shared learning with Obesity UK members, through a presentation at one of the Autumn/Winter patient groups.