{"id":16248,"date":"2023-08-03T10:09:47","date_gmt":"2023-08-03T09:09:47","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=16248"},"modified":"2026-03-04T14:35:30","modified_gmt":"2026-03-04T14:35:30","slug":"diabetes-remission","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/diabetes\/diabetes-remission\/","title":{"rendered":"Diabetes Remission"},"content":{"rendered":"\n<p><strong>Information<\/strong>&nbsp;<\/p>\n\n\n\n<h5 class=\"wp-block-heading\"><strong>Definition:&nbsp;&nbsp;<\/strong><\/h5>\n\n\n\n<p>The international criteria for&nbsp;remission&nbsp;of type 2 diabetes&nbsp;agreed in 2021 states:&nbsp;&nbsp;<\/p>\n\n\n\n<p>\u201cA person is in&nbsp;remission&nbsp;of T2DM if they have&nbsp;an <span style=\"text-decoration: underline\">HbA1c &lt;48mmol\/L for at least 3 months&nbsp;<\/span><strong>AND<\/strong>&nbsp;<span style=\"text-decoration: underline\">they have not taken any medications to control their blood glucose levels during this time<\/span>\u201d.&nbsp;<\/p>\n\n\n\n<h5 class=\"wp-block-heading\"><strong>Coding:&nbsp;&nbsp;<\/strong><\/h5>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Code as \u2018diabetes in remission&nbsp;&#8216; C10p.&nbsp;<\/li>\n\n\n\n<li>Retain original T2DM code C109-2 as people in remission of diabetes &nbsp;should continue to be monitored at the same rate \u2013 this includes foot and retinopathy screening recall systems. Useful 9 processes of care infographic to follow.<\/li>\n\n\n\n<li><strong>Do not use<\/strong> the code <strong><em>\u2018diabetes resolved\u2019<\/em><\/strong>. It is reserved <strong><u>only<\/u>&nbsp;<\/strong>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.&nbsp;&nbsp;<\/li>\n<\/ul>\n\n\n\n<h5 class=\"wp-block-heading\"><strong>Referral to Type 2 Remission through Counterweight Plus:<\/strong><\/h5>\n\n\n\n<p>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.&nbsp; <a href=\"https:\/\/www.counterweight.org\/pages\/nhs-scotland-type-2-diabetes-programme\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Scotland &#8211; Type 2 Diabetes Programme | Counterweight<\/a><\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<h5 class=\"wp-block-heading\"><strong>Local Delivery<\/strong><strong><\/strong><\/h5>\n\n\n\n<p>This is a 1-year intensive weight loss programme, offering a structured evidence-based approach delivered by a Registered Dietitian specialising in this programme.&nbsp; Specialist psychology support, if needed alongside the programme is available with our clinical psychologist.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>Delivery is via a mix of 1:1 and group video appointments but telephone and face to face appointments can also be arranged.<\/p>\n\n\n\n<p><strong>M.A\/D.R.M &amp; L.E 04-03-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who can refer:<\/strong>&nbsp;&nbsp;<\/h4>\n\n\n\n<p>General Practitioners&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong>&nbsp;<\/h4>\n\n\n\n<p>Patients can be referred if they meet the following criteria:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Adults aged 18-65 years<\/li>\n\n\n\n<li>T2DM diagnosis in past 0-6 years<\/li>\n\n\n\n<li>HbA1c \u226548mmol\/mol at last check within 12 months, if on diet alone or<\/li>\n\n\n\n<li>HbA1c \u226543mmol\/mol if on treatment with oral hypoglycaemic agents<\/li>\n\n\n\n<li>Ethnic Minorities: Body Mass Index (BMI) of 25 or above<\/li>\n\n\n\n<li>White Caucasian: Body Mass Index (BMI) of 27 or above<\/li>\n<\/ul>\n\n\n\n<p><strong>Additional Considerations:<\/strong><\/p>\n\n\n\n<p>It would be more appropriate to refer the following patients to the <strong>local NHS Lothian programme<\/strong>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients who have an HbA1c &gt;87mmol\/mol which would exclude them from referral to the national programme.<\/li>\n\n\n\n<li>Those unable to use an app, chat function and video calls for the appointments on a device like a smartphone, tablet or laptop.<\/li>\n\n\n\n<li>Relationship with food: If the patient has in the <em>past<\/em> 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 <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/mentalhealthadult\/eating-disorders-adult\/\" target=\"_blank\" rel=\"noreferrer noopener\">Eating Disorders (Adult) \u2013 RefHelp<\/a> &nbsp;or (if mild-moderate), can self-refer to Beat for guided self-help: <a href=\"https:\/\/www.beateatingdisorders.org.uk\/get-information-and-support\/get-help-for-myself\/momentum\/\" target=\"_blank\" rel=\"noreferrer noopener\">Momentum<\/a><\/li>\n\n\n\n<li><em>Please provide the Counterweight Plus Information Leaflet to patients prior to referral&nbsp;&nbsp;<\/em><a href=\"https:\/\/services.nhslothian.scot\/awmt2d\/wp-content\/uploads\/sites\/24\/2022\/05\/Lothian-Leaflet-Counterweight-Plus-A5-Roll-Fold-Leaflet-0821-DIGITAL-Lothian.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong><em>Counterweight Plus Information Leaflet.pdf<\/em><\/strong><\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who&nbsp;not to refer:<\/strong>&nbsp;<\/h4>\n\n\n\n<p>Unfortunately we cannot accept patients that:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Are currently prescribed insulin to treat their Type 2 Diabetes<\/li>\n\n\n\n<li>Have an eGFR &lt;30 mls\/min\/1.732 ie CKD &gt;stage 3<\/li>\n\n\n\n<li>Have Severe or unstable Heart Failure defined as equivalent to the New York Heart Association (NYHA) classifications, grade 3. (<a href=\"https:\/\/www.heart.org\/en\/health-topics\/heart-failure\/what-is-heart-failure\/classes-of-heart-failure\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.heart.org\/en\/health-topics\/heart-failure\/what-is-heart-failure\/classes-of-heart-failure<\/a>)<\/li>\n\n\n\n<li>Have suffered from a Myocardial infarction within previous 6 months<\/li>\n\n\n\n<li>Are pregnant, breastfeeding or actively trying to conceive<\/li>\n\n\n\n<li>Have a current or suspected eating disorder and\/or active purging<\/li>\n\n\n\n<li>Are actively misusing or dependent on alcohol or other substances<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong>&nbsp;&nbsp;<\/h4>\n\n\n\n<p>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.<\/p>\n\n\n\n<p><strong>National service:<\/strong> Sci-gateway \u2013 Special Health Boards &gt; National Diabetes Programmes &gt; National Type 2 Diabetes Remission Programme &gt; Type 2 Diabetes Remission &gt; National T2 Diabetes Remission<\/p>\n\n\n\n<p><strong>Local service:<\/strong> Sci-gateway \u2013 AHP Dietician &gt; weight management &gt; T2DM Remission<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Contacts<\/strong>:<\/h4>\n\n\n\n<p>For queries relating to the national programme, please contact: <a href=\"mailto:gjnh.cfsdinnovationteam@gjnh.scot.nhs.uk\" target=\"_blank\" rel=\"noreferrer noopener\">gjnh.cfsdinnovationteam@gjnh.scot.nhs.uk<\/a><\/p>\n\n\n\n<p>For queries about local remission services or referral processes, please contact: <a href=\"mailto:loth.weightmanagement@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.weightmanagement@nhs.scot<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li>Please provide the Counterweight Plus Information Leaflet to patients prior to referral to ensure patients interest in the programme\u00a0<a href=\"https:\/\/services.nhslothian.scot\/awmt2d\/wp-content\/uploads\/sites\/24\/2022\/05\/Lothian-Leaflet-Counterweight-Plus-A5-Roll-Fold-Leaflet-0821-DIGITAL-Lothian.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Counterweight Plus Information Leaflet.pdf<\/a><\/li>\n\n\n\n<li>Please ensure first line dietary and lifestyle advice has been provided to the patient prior to referral.<\/li>\n\n\n\n<li>Those who do not think this programme would be realistic for them can be referred to our routine weight management service <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dietetics\/weightmanagementserviceadult\/\" data-type=\"page\" data-id=\"4513\" target=\"_blank\" rel=\"noreferrer noopener\">Weight Management Service Adult \u2013 RefHelp (nhslothian.scot)<\/a><\/li>\n\n\n\n<li>For patients who are eligible for DESMOND, please refer to this service at the same time. <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dietetics\/weightmanagementserviceadult\/desmond\/\" data-type=\"page\" data-id=\"19319\" target=\"_blank\" rel=\"noreferrer noopener\">DESMOND \u2013 RefHelp (nhslothian.scot)<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Information on the National Digital Remission Programme<\/p>\n\n\n\n<p><a href=\"https:\/\/www.counterweight.org\/pages\/nhs-scotland-type-2-diabetes-programme\" target=\"_blank\" rel=\"noreferrer noopener\">NHS Scotland &#8211; Type 2 Diabetes Programme | Counterweight<\/a><\/p>\n\n\n\n<p>NHS Lothians Local Remission Programme<\/p>\n\n\n\n<p><strong><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fservices.nhslothian.scot%2Fawmt2d%2Ftype-2-diabetes-remission-through-counterweight-plus%2F&amp;data=05%7C01%7CSusannah.Scarlett%40nhslothian.scot.nhs.uk%7Ca2eef0ce2c0045987e6908db78dff887%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638236675935576584%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&amp;sdata=qHXC%2FB%2Fs9Tnbil2PvmUZbNu4YzJLDPZQuHC08XXQmVQ%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">Type 2 Diabetes&nbsp;Remission&nbsp;through Counterweight Plus \u2013 Adult Weight Management and Type 2 Diabetes Prevention Service (nhslothian.scot)<\/a><\/strong>&nbsp;<\/p>\n\n\n\n<p>Counterweight Plus information leaflet: &nbsp;<a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fservices.nhslothian.scot%2Fawmt2d%2Fwp-content%2Fuploads%2Fsites%2F24%2F2022%2F02%2FGMwC_Leaflet.pdf&amp;data=05%7C01%7CSusannah.Scarlett%40nhslothian.scot.nhs.uk%7Ca2eef0ce2c0045987e6908db78dff887%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638236675935576584%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&amp;sdata=b2ExyB6pL5xp0Y5MPNQS3iflk6Rgd6CpGHwTOKoSaHE%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/awmt2d\/wp-content\/uploads\/sites\/24\/2022\/02\/GMwC_Leaflet.pdf<\/a>&nbsp;<\/p>\n\n\n\n<p>Diabetes UK information prescriptions: <a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.diabetes.org.uk%2Fprofessionals%2Fresources%2Fresources-to-improve-your-clinical-practice%2Finformation-prescriptions-qa&amp;data=05%7C01%7CSusannah.Scarlett%40nhslothian.scot.nhs.uk%7Ca2eef0ce2c0045987e6908db78dff887%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638236675935576584%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&amp;sdata=DQiP7OEdsCg9%2BEcNy1tGtpmqBwbvTttJBVw9Lx6Jppg%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.diabetes.org.uk\/professionals\/resources\/resources-to-improve-your-clinical-practice\/information-prescriptions-qa<\/a>&nbsp;&nbsp;<\/p>\n\n\n\n<p>Diabetes UK Diabetes and Driving&nbsp;<a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.diabetes.org.uk%2Fguide-to-diabetes%2Flife-with-diabetes%2Fdriving&amp;data=05%7C01%7CSusannah.Scarlett%40nhslothian.scot.nhs.uk%7Ca2eef0ce2c0045987e6908db78dff887%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638236675935576584%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&amp;sdata=%2Fc6iaDsKaayqHVfPGMmVn1Swqk2IDllkBy10hGEfp1o%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.diabetes.org.uk\/guide-to-diabetes\/life-with-diabetes\/driving<\/a>&nbsp;<\/p>\n\n\n\n<p>Diabetes and `Driving GOCVUK&nbsp;<a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.gov.uk%2Fdiabetes-driving&amp;data=05%7C01%7CSusannah.Scarlett%40nhslothian.scot.nhs.uk%7Ca2eef0ce2c0045987e6908db78dff887%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638236675935576584%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&amp;sdata=NE6hvbCBjo958%2FW5VXo89rkSfFrc%2FRTUY6G9RFxF7yU%3D&amp;reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.gov.uk\/diabetes-driving<\/a><\/p>\n\n\n\n<p>Lothian Wellbeing Lifestyle Change Resources: <a href=\"https:\/\/services.nhslothian.scot\/wellbeinglothian\/manage-your-weight\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/services.nhslothian.scot\/wellbeinglothian\/manage-your-weight\/<\/a><\/p>\n\n\n\n<p>Diabetes UK Type 2 Diabetes: <a href=\"https:\/\/www.diabetes.org.uk\/diabetes-the-basics\/types-of-diabetes\/type-2\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.diabetes.org.uk\/diabetes-the-basics\/types-of-diabetes\/type-2<\/a>&nbsp;<\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Information&nbsp; Definition:&nbsp;&nbsp; The international criteria for&nbsp;remission&nbsp;of type 2 diabetes&nbsp;agreed in 2021 states:&nbsp;&nbsp; &ldquo;A person is in&nbsp;remission&nbsp;of T2DM if they have&nbsp;an HbA1c &lt;48mmol\/L for at least 3 months&nbsp;AND&nbsp;they have not taken any medications to control their blood glucose levels during this time&rdquo;.&nbsp; Coding:&nbsp;&nbsp; Referral to Type 2 Remission through Counterweight Plus: We would encourage GPs to<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3854,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[978],"class_list":["post-16248","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-diabetes-remission"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/diabetes\/https-apps-nhslothian-scot-refhelp-diabetes-remission\/\" rel=\"tag\">Diabetes Remission<\/a>","rttpg_excerpt":"Information&nbsp; Definition:&nbsp;&nbsp; The international criteria for&nbsp;remission&nbsp;of type 2 diabetes&nbsp;agreed in 2021 states:&nbsp;&nbsp; &ldquo;A person is in&nbsp;remission&nbsp;of T2DM if they have&nbsp;an HbA1c &lt;48mmol\/L for at least 3 months&nbsp;AND&nbsp;they have not taken any medications to control their blood glucose levels during this time&rdquo;.&nbsp; Coding:&nbsp;&nbsp; Referral to Type 2 Remission through Counterweight Plus: We would encourage GPs to","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/16248","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=16248"}],"version-history":[{"count":16,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/16248\/revisions"}],"predecessor-version":[{"id":27149,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/16248\/revisions\/27149"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3854"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=16248"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=16248"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}