This low-calorie diet service for people with Type 2 diabetes launched across NCL in November 2020, as part of a two-year pilot. NCL is one of 10 sites across England that will be rolling out the new, innovative and free service. Five hundred patient places will be available.
The NCL service, offered by Xyla Health and Wellbeing, provides a digitally led one-year programme to support healthier lifestyle, weight loss, and remission of Type 2 diabetes. The programme is based on two large studies, which showed that, because of low-calorie diet treatment, people living with Type 2 diabetes who were overweight could improve their diabetes control, reduce diabetes-related medication and even achieve remission.
The one-year programme consists of 12 weeks of low-calorie total diet replacement (shakes and soups, products provided by Xyla Health and Wellbeing) followed by reintroducing food, focusing on movement and maintaining a new healthy eating lifestyle. The unique programme:
- combines specialist nutrition, psychology and physical activity
- supports rapid weight loss and long-term behaviour change
- delivered entirely remotely via the Xyla Health and Wellbeing app, with supporting resources and 1-2-1 telephone coaching
- delivered by Xyla Health and Wellbeing, GPs, practice nurses, diabetes practitioners, dietitians, clinical psychologists and exercise specialists
Referrals to the service are made from primary care. To reduce workload on practices, the NCL low-calorie diet steering group advises that practices may wish to operate at a PCN level to identify eligible patients and make referrals; for example, the PCN practice-based-pharmacist could lead on engaging with the service.
Low-calorie diet eligibility searches are now available on practice clinical systems to support identification of appropriate patients. It is important that all patients who are referred must be engaged and committed to taking part in the 12-month programme. Some practices may have already been contacted by interested patients. It is recommended to get back in touch with engaged patients to discuss eligibility for the service.
Please see the Downloads section for the Medication Changes Guidelines, practice patient allocation profile and several other useful resources including FAQs.
Watch the NCL Low Calorie Diet Service Virtual Training Session video recording (see Related Video on the right).
Patient resources include:
- aged 18-65
- diagnosed with Type 2 diabetes within the last six years
- BMI of 27kg/m2 or higher (adjusted to 25kg/m2 or higher in Black, Asian and Minority Ethnic (BAME) people)
- a BMI obtained from self-measured weight is acceptable for referral. If this cannot be obtained, a clinic-measured value within the last 12 months may be used, provided there is no concern that weight may have reduced since last measured such that the individual would not be eligible for the programme at present.
- HbA1c measurement taken within the last 12 months, with values as follows:
- if on diabetes medication, HbA1c 43 mmol/mol or higher
- if not on diabetes medication, HbA1c 48 mmol/mol or higher
- in all cases, HbA1c must be 87 mmol/mol or lower
- if there is any concern that HbA1c may have changed since last measured, such that repeat testing may indicate that the individual would not be eligible for the programme at present, HbA1c should be rechecked before referral is considered
- have attended a monitoring and diabetes review when this was last offered, including retinal screening, and commit to continue attending annual reviews, even if remission is achieved
- current insulin user
- pregnant or planning to become pregnant within the next 6 months
- currently breastfeeding
- has at least one of the following significant co-morbidities; active cancer, heart attack or stroke in last six months, severe heart failure (defined as New York Heart Association grade 3 or 4), severe renal impairment (most recent eGFR less than 30mls/min/1.73m2) or active liver disease (not including NAFLD) or active substance use disorder, active eating disorder, porphyria, known proliferative retinopathy that has not been treated
- has weight loss of greater than five per cent body weight in the past six months, or is currently on a weight management programme
- has had, or is awaiting, bariatric surgery (unless willing to come off waiting list)
- health professional assessment that the person is unable to understand or meet the demands of the NHS LCD Programme and/or monitoring requirements (due to physical or psychological conditions or co-morbidities)
How to refer
The following clinicians can refer to this service:
Referral methods: Email, EMIS managed referral
After discussing the service with your patient and confirming eligibility for the pathway, complete the NHS Low Calorie Diet Referral NCLCCG v8.1 and email to Scwcsu.firstname.lastname@example.org
Where to find the form
Barnet: BAR Global Documents > Referral Forms (BAR Global)
Enfield: ENF Global Documents > Dietetics
Haringey: HAR Global Documents > Nutrition & Dietetics
Islington: ISL Global Documents > Nutrition & Dietetics
Camden: Camden EMIS Forms page