Diabetes Remission

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.

Patients who wish to try to achieve remission of diabetes can be referred to the two-year intensive weight loss programme ‘Counterweight Plus’ programme Type 2 Diabetes Remission through Counterweight Plus – Adult Weight Management and Type 2 Diabetes Prevention Service (nhslothian.scot)

Who can refer:

General Practictioners

Secondary care

Self referral

Who to refer:

Diagnosed with Type 2 Diabetes within the last 6 years with:

BMI >27kg/m² (no upper BMI limit) 
Aged 18-65 years 
Diet controlled with HbA1c >48mmol/mol,  or on oral agents e.g. metformin with HbA1c >43mmol/mol

Who not to refer:

Patients who:

Are on insulin
Have a diagnosis of current eating disorder or potential binge eating disorder. Please see the Cullen Centre Ref Help page for further details.

Have uncontrolled hypothyroidism
Have unstable psychosis or severe and unstable personality disorder
Have current alcohol or drug dependency
Are pregnant (If BMI over 40kg/m2 can be referred by midwives to Metabolic Antenatal Clinic)
Have dementia
Have a moderate to severe learning disability (please refer to the Learning Disability team)

How to refer:

Sci gateway > weight management > remission programme

The weight management team can provide access to other approaches to weight loss such as Second Nature, MyDesmond App, Get moving with Counterweight as well as bariatric surgery services.

Diabetes UK information prescriptions can also be helpful as a template for patient led lifestyle interventions.

Counterweight Plus information leaflet. https://services.nhslothian.scot/awmt2d/wp-content/uploads/sites/24/2022/02/GMwC_Leaflet.pdf

Diabetes UK information for patients https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/type2-diabetes-remission

Diabetes UK information for professionals https://www.diabetes.org.uk/professionals/resources/shared-practice/remission

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