Specific research recommendations are provided within each of the threaded publications, but key overarching areas of future research required to build on learning from this study include the following:
- As this study only provides an evaluation of the initial programme pilot, there is a need to assess the long-term clinical, equity and economic impact of the now nationally available NHS T2D Path to Remission Programme. This research should include qualitative follow-up of diverse lived experiences, and assessment of weight and HbA1c trajectories of participants post 52 weeks (programme end), to determine if, and how rapidly, service users return to their baseline values, in order to further develop the cost-effectiveness models and strategies to prevent weight regain and loss of glycaemic control.
- Further inequalities research is required to further understand and improve:
- - the completion rates and retention in service users aged 18–39 years, in the most deprived quintile, and with a higher (40+) starting BMI, who are currently least likely to complete
- - the reduced weight loss seen by Asian and black service users
- - the pre-referral process, in order to understand the characteristics and support needs of those who were offered but declined a referral to the programme.
- Given this evaluation was undertaken during the COVID-19 pandemic, a quantitative analysis of the costs and health outcomes of the NHS T2D Path to Remission programme in the post-pandemic environment is required. This should include an analysis of changes made to the national roll-out, as well as further analyses linking behaviour change theory and techniques to clinical outcomes, which was not possible in the current study. Evaluation of subsequent years of programme provision is also required to elucidate the impact of changes to the programme specification, made as a result of the findings from the initial evaluation.
- Additional clinical research is required to further understand why some service users do, and some do not, achieve T2D remission.
- Given the prevalence and impact of mental health challenges, and emotional and disordered eating in people seeking weight management support, that were also identified in some service users, further research is required to understand: prevalence rates in this population, how this changes in response to the programme and opportunities to optimise support and outcomes, both during and after programme completion.
- As a result of the observed ongoing reliance on TDR products by some service users, it is important to examine the impact of long-term TDR use, including cost and equity, and the impact on dietary intake, the gut microbiome, and long-term weight and glycaemic control.