Weight loss => T2D remission via a group-based, ethnically diverse service

[Eddy Edson]

Real-World Data of a Group-Based Formula Low Energy Diet Programme in Achieving Type 2 Diabetes Remission and Weight Loss in an Ethnically Diverse Population in the UK: A Service Evaluation

(1) Background: Formula low energy diets (LED) are effective at inducing weight loss and type 2 diabetes (T2DM) remission. However, the effect of LED programmes in ethnic minority groups in the UK is unknown. (2) Methods: A service-evaluation was undertaken of a group-based LED, total diet...

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Evaluation of a DiRECT-inspired but group-based and ethnically diverse T2D weight loss remission service in Hackney.

(But how much does it cost to deliver?)

Abstract​

(1) Background: Formula low energy diets (LED) are effective at inducing weight loss and type 2 diabetes (T2DM) remission. However, the effect of LED programmes in ethnic minority groups in the UK is unknown. (2) Methods: A service-evaluation was undertaken of a group-based LED, total diet replacement (TDR) programme in London, UK. The programme included: a 12-week TDR phase, 9-week food reintroduction and a 31-week weight maintenance phase and was delivered by a diabetes multi-disciplinary team. (3) Results: Between November 2018 and March 2020, 216 individuals were referred, 37 commenced the programme, with 29 completing (78%). The majority were of Black British (20%) ethnicity with a mean (SD) age of 50.4 (10.5) years, a body mass index of 34.4 (4.4) kg/m2 and a T2DM duration of 4.2 (3.6) years. At 12 months, 65.7% achieved T2DM remission, with a mean bodyweight loss of 11.6 (8.9) kg. Completers lost 15.8 (5.3) kg, with 31.4% of participants achieving ≥15 kg weight loss. Quality of life measures showed significant improvements. (4) Conclusions: This service evaluation shows for the first time in the UK that a group-based formula LED programme can be effective in achieving T2DM remission and weight loss in an ethnical diverse population.

Researcher's thread:

https://twitter.com/x/status/1553767091886608385

 

[Deleted member 21371]

It seems at least fat has no agenda.

 

[Windy]

Interesting paper, thanks for posting it @Eddy Edson. I found it a bit sad that 14 of the people who applied couldn't afford the £40 per week for the meal replacements, so didn't get to be part of the trial, nor to try for remission.
The paper goes on to say that people of Somali origin were over represented in the "can't afford to self fund" group, so whilst fat doesn't have an agenda, poverty does, or at least availability of spare money for special meals.

I hope that if/when the low calorie Newcastle type meal replacement programme gets rolled out across the country, people can get the meals on prescription if they can't afford to buy them, as it would be cheaper for the NHS in the longer term if T2s get remission than the NHS funding diabetes medication and future treatment.

 

[Deleted member 21371]

Interesting paper, thanks for posting it @Eddy Edson. I found it a bit sad that 14 of the people who applied couldn't afford the £40 per week for the meal replacements, so didn't get to be part of the trial, nor to try for remission.
The paper goes on to say that people of Somali origin were over represented in the "can't afford to self fund" group, so whilst fat doesn't have an agenda, poverty does, or at least availability of spare money for special meals.

I hope that if/when the low calorie Newcastle type meal replacement programme gets rolled out across the country, people can get the meals on prescription if they can't afford to buy them, as it would be cheaper for the NHS in the longer term if T2s get remission than the NHS funding diabetes medication and future treatment.

I can't say what the average spend per meal is, the UK tends to class £1 a head as a budget option, but I found using Tesco shakes was a cheaper than actually buying food.
Pack of ten, £4.
I had 3 a day, so I spent less than £10 a week.
Add to that a few pints of skimmed milk, which I bought for tea and coffee normally, and some veg of salad, which replaced all the snacks.
I agree, apart from all the health benefits, it is a lot cheaper to reverse diabetes and avoid future problems, but unfortunately that's spending money now, and politicians seem to prefer to mortgage the future, and just push problems onto future generations

 

[Windy]

I can't say what the average spend per meal is, the UK tends to class £1 a head as a budget option, but I found using Tesco shakes was a cheaper than actually buying food.
Pack of ten, £4.
I had 3 a day, so I spent less than £10 a week.
Add to that a few pints of skimmed milk, which I bought for tea and coffee normally, and some veg of salad, which replaced all the snacks.

My reading of the paper is that they had to use the Counterweight products, so couldn't shop about for cheaper ones and be part of the trial. But point taken, there's cheaper ways of doing it. I'm guessing that the trail used a standard product to standardise the study.

I agree, apart from all the health benefits, it is a lot cheaper to reverse diabetes and avoid future problems, but unfortunately that's spending money now, and politicians seem to prefer to mortgage the future, and just push problems onto future generations

The short termism is quite depressing.

And the benefits radiate out, so if Mrs Miggins got remission, she'll tell her friend with recently diagnosed T2 diabetes about it, and how it's worked for her, and hopefully they try for it too, and minimise future costs to themselves with their health, and the NHS with having to treat potentially preventable, avoidable complications.

 

[Eddy Edson]

My reading of the paper is that they had to use the Counterweight products, so couldn't shop about for cheaper ones and be part of the trial. But point taken, there's cheaper ways of doing it. I'm guessing that the trail used a standard product to standardise the study.

The short termism is quite depressing.

And the benefits radiate out, so if Mrs Miggins got remission, she'll tell her friend with recently diagnosed T2 diabetes about it, and how it's worked for her, and hopefully they try for it too, and minimise future costs to themselves with their health, and the NHS with having to treat potentially preventable, avoidable complications.

I'd like to see some numbers - how much it costs to deliver the service per patient on average, versus estimates of average healthcare costs avoided.

IMO a really big issue is how intensive the service has to be (in terms of support by qualified HCP's etc) for how long. There's a whole bunch of studies of intervention programs showing average weight loss of around 5% long term, with big variability, even with continued intervention at some intensity.

And it doesn't matter if it's "low carb" or "low fat" or whatever:



If you're a hard-headed health economist trying to work out what to fund, long term success rates at what kind of average cost is a really big question.

FWIW, IMO the case for long-term semaglutide or other new-age weight management meds is crystal clear.

 

[Windy]

I'd like to see some numbers - how much it costs to deliver the service per patient on average, versus estimates of average healthcare costs avoided.

Xin et al. did a paper on it
Xin, Y., Davies, A., McCombie, L., Briggs, A., Messow, C.M., Grieve, E., Leslie, W.S., Taylor, R. and Lean, M.E., 2019. Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight‐Plus weight management programme within a primary care randomized controlled trial. Diabetic Medicine, 36(8), pp.1003-1012.
"One-year incremental cost for the intervention group was estimated at £982 (95% CI £732, £1,258) per participant compared to the control arm.
Providing the DiRECT/Counterweight-Plus intervention in primary care incurs a cost (£2,359 per one-year diabetes remission) below the average annual direct cost of managing a person with Type 2 diabetes (including complications), and has the potential for long-term cost effectiveness"

[study funded by DUK]

 

[Eddy Edson]

Xin et al. did a paper on it
Xin, Y., Davies, A., McCombie, L., Briggs, A., Messow, C.M., Grieve, E., Leslie, W.S., Taylor, R. and Lean, M.E., 2019. Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight‐Plus weight management programme within a primary care randomized controlled trial. Diabetic Medicine, 36(8), pp.1003-1012.
"One-year incremental cost for the intervention group was estimated at £982 (95% CI £732, £1,258) per participant compared to the control arm.
Providing the DiRECT/Counterweight-Plus intervention in primary care incurs a cost (£2,359 per one-year diabetes remission) below the average annual direct cost of managing a person with Type 2 diabetes (including complications), and has the potential for long-term cost effectiveness"

[study funded by DUK]

I didn't understand the details of that paper when it came out & on a quick re-skim, I still don't. I'll try again tomorrow.

I do note the caveats:

Providing a reasonable proportion of remissions can be maintained for a period of time, with multiple medical gains expected, as well as immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with 28 diabetes to attempt remission as early as possible after diagnosis.

Once again, the devil seems to be in this detail: Providing a reasonable proportion of remissions can be maintained for a period of time ...

I'd also note that this came out after the 12 month results but before the 24 month data, which showed attenuation of the remission rate.

 

[Windy]

Once again, the devil seems to be in this detail: Providing a reasonable proportion of remissions can be maintained for a period of time ...

I've had a root through Google Scholar to see if I can find a paper on long term remission for T2s, and can't seem to find one for dieting weight loss based remission, longer term, though there are a number for remission via bariatric surgery.
If you can find one Eddy, I'd be interested in reading it.

I have in the back of my mind that failure with my diet is always an option, as I've lost and gained weight before, but this is the best I've done (30kg), as I know the diabetes fairy is sat on my shoulder now, and that's motivated me for the moment.
Sarah

 

[Eddy Edson]

I didn't understand the details of that paper when it came out & on a quick re-skim, I still don't. I'll try again tomorrow.

I do note the caveats:

Providing a reasonable proportion of remissions can be maintained for a period of time, with multiple medical gains expected, as well as immediate social benefits, there is a case for shifting resources within diabetes care budgets to offer support for people with 28 diabetes to attempt remission as early as possible after diagnosis.

Once again, the devil seems to be in this detail: Providing a reasonable proportion of remissions can be maintained for a period of time ...

I'd also note that this came out after the 12 month results but before the 24 month data, which showed attenuation of the remission rate.

Anyway, the analysis was updated for the 24 month results, so best tofocus on this paper: https://link.springer.com/article/10.1007/s00125-020-05224-2

Unlike the 12 month paper, it has an actual numerical estimate of lifetime cost savings:

Results​

Mean total 2 year healthcare costs for the intervention and control groups were £3036 and £2420, respectively: an incremental cost of £616 (95% CI –£45, £1269). Intervention costs (£1411; 95% CI £1308, £1511) were partially offset by lower other healthcare costs (£796; 95% CI £150, £1465), including reduced oral glucose-lowering medications by £231 (95% CI £148, £314). Net remission at 2 years was 32.3% (95% CI 23.5%, 40.3%), and cost per remission achieved was £1907 (lower 95% CI: intervention dominates; upper 95% CI: £4212). Over a lifetime horizon, the intervention was modelled to achieve a mean 0.06 (95% CI 0.04, 0.09) QALY gain for the DiRECT population and mean total lifetime cost savings per participant of £1337 (95% CI £674, £2081), with the intervention becoming cost-saving within 6 years.

I'll dig further into it tomorrow if I have time.

 

[Eddy Edson]

I've had a root through Google Scholar to see if I can find a paper on long term remission for T2s, and can't seem to find one for dieting weight loss based remission, longer term, though there are a number for remission via bariatric surgery.
If you can find one Eddy, I'd be interested in reading it.

I have in the back of my mind that failure with my diet is always an option, as I've lost and gained weight before, but this is the best I've done (30kg), as I know the diabetes fairy is sat on my shoulder now, and that's motivated me for the moment.
Sarah

There are plenty looking at long-term weight loss trajectories, which seems like an appropriate benchmark. The best place to start AFAIK is the big long-term Look AHEAD trial. Eg: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904491/

 

[Windy]

I'll have a go at reading it tomorrow. I skimmed through it today, but it needs a re-read with a fresh brain. Some of the stats and discussion lost me.
Cheers for the link