Information
Definition:
The international criteria for remission of type 2 diabetes agreed in 2021 states:
“A person is in remission of T2DM if they have an HbA1c <48mmol/L for at least 3 months AND they have not taken any medications to control their blood glucose levels during this time”.
Coding:
- Code as ‘diabetes in remission ‘ C10p.
- Retain original T2DM code C109-2 as people in remission of diabetes should continue to be monitored at the same rate – this includes foot and retinopathy screening recall systems. Useful 9 processes of care infographic to follow.
- Do not use the code ‘diabetes resolved’. It is reserved only for cases of misdiagnosis or diabetes due to a secondary factor that has since been removed, such as acute steroid use. These patients no longer require annual review for diabetes.
Referral to Type 2 Remission through Counterweight Plus:
We would encourage GPs to refer to the national digital programme as first line as this offers the fastest route to treatment with a shorter wait time for patients. NHS Scotland – Type 2 Diabetes Programme | Counterweight
The NHS Lothian type 2 diabetes remission programme will continue to offer treatment for those patients who are not suitable for, or who do not want to take part in a fully remote, digital programme.
NHS Lothian use the same Counterweight products and resources as the national programme so there is no difference in terms of the treatment content or duration between local and national services. The NHS Lothian programme is delivered by specialist dietitians and psychologists in the weight management service.
Local Delivery
This is a 1-year intensive weight loss programme, offering a structured evidence-based approach delivered by a Registered Dietitian specialising in this programme. Specialist psychology support, if needed alongside the programme is available with our clinical psychologist.
It incorporates three phases; total diet replacement (800kcal/day) for approximately 12 weeks, a stepped food reintroduction phase and then a weight loss maintenance phase.
Delivery is via a mix of 1:1 and group video appointments but telephone and face to face appointments can also be arranged.
M.A/D.R.M & L.E 04-03-26
Who can refer:
General Practitioners
Who to refer:
Patients can be referred if they meet the following criteria:
- Adults aged 18-65 years
- T2DM diagnosis in past 0-6 years
- HbA1c ≥48mmol/mol at last check within 12 months, if on diet alone or
- HbA1c ≥43mmol/mol if on treatment with oral hypoglycaemic agents
- Ethnic Minorities: Body Mass Index (BMI) of 25 or above
- White Caucasian: Body Mass Index (BMI) of 27 or above
Additional Considerations:
It would be more appropriate to refer the following patients to the local NHS Lothian programme:
- Patients who have an HbA1c >87mmol/mol which would exclude them from referral to the national programme.
- Those unable to use an app, chat function and video calls for the appointments on a device like a smartphone, tablet or laptop.
- Relationship with food: If the patient has in the past had a disordered relationship with food, and/or there are some concerns about their current relationship with food (for example occasional binge eating or emotional eating), the local service has a Clinical Psychologist who can work with patients to address these issues. Anyone with suspected binge eating disorder who has not already had treatment for this would be more appropriately supported for their eating disorder first by the Lothian Eating Disorders Service Eating Disorders (Adult) – RefHelp or (if mild-moderate), can self-refer to Beat for guided self-help: Momentum
- Please provide the Counterweight Plus Information Leaflet to patients prior to referral Counterweight Plus Information Leaflet.pdf
Who not to refer:
Unfortunately we cannot accept patients that:
- Are currently prescribed insulin to treat their Type 2 Diabetes
- Have an eGFR <30 mls/min/1.732 ie CKD >stage 3
- Have Severe or unstable Heart Failure defined as equivalent to the New York Heart Association (NYHA) classifications, grade 3. (https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-of-heart-failure)
- Have suffered from a Myocardial infarction within previous 6 months
- Are pregnant, breastfeeding or actively trying to conceive
- Have a current or suspected eating disorder and/or active purging
- Are actively misusing or dependent on alcohol or other substances
How to refer:
Referral for remission services for both national and local programmes is via Sci-gateway. Please note that there is a different referral protocol for each.
National service: Sci-gateway – Special Health Boards > National Diabetes Programmes > National Type 2 Diabetes Remission Programme > Type 2 Diabetes Remission > National T2 Diabetes Remission
Local service: Sci-gateway – AHP Dietician > weight management > T2DM Remission
Contacts:
For queries relating to the national programme, please contact: gjnh.cfsdinnovationteam@gjnh.scot.nhs.uk
For queries about local remission services or referral processes, please contact: loth.weightmanagement@nhs.scot
- Please provide the Counterweight Plus Information Leaflet to patients prior to referral to ensure patients interest in the programme Counterweight Plus Information Leaflet.pdf
- Please ensure first line dietary and lifestyle advice has been provided to the patient prior to referral.
- Those who do not think this programme would be realistic for them can be referred to our routine weight management service Weight Management Service Adult – RefHelp (nhslothian.scot)
- For patients who are eligible for DESMOND, please refer to this service at the same time. DESMOND – RefHelp (nhslothian.scot)
Information on the National Digital Remission Programme
NHS Scotland – Type 2 Diabetes Programme | Counterweight
NHS Lothians Local Remission Programme
Counterweight Plus information leaflet: https://services.nhslothian.scot/awmt2d/wp-content/uploads/sites/24/2022/02/GMwC_Leaflet.pdf
Diabetes UK information prescriptions: https://www.diabetes.org.uk/professionals/resources/resources-to-improve-your-clinical-practice/information-prescriptions-qa
Diabetes UK Diabetes and Driving https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/driving
Diabetes and `Driving GOCVUK https://www.gov.uk/diabetes-driving
Lothian Wellbeing Lifestyle Change Resources: https://services.nhslothian.scot/wellbeinglothian/manage-your-weight/
Diabetes UK Type 2 Diabetes: https://www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes/type-2
