Diabetes Remission Programme (National)
DGRefHelp - NHS Dumfries & Galloway
What it is: A national, digitally-delivered, 12-month structured weight-loss programme (delivered by Counterweight) to help people with Type 2 Diabetes achieve remission — HbA1c <48 mmol/mol for at least 3 months off glucose-lowering medication.
NHS D&G is live for referrals. Referral is via SCI Gateway.
Background
The programme consists of a total diet replacement along with support from behaviour-change coaches including dietitians.
It is based on the DiRECT trial evidence that structured weight loss can induce remission in Type 2 Diabetes.
Patients receive virtual coaching, weekly app-based monitoring uploads, and free equipment (glucose meter, scales, and BP monitor if hypertensive). Vegan, vegetarian, kosher, halal, and gluten-free options are accommodated.
3000 places have been funded nationally over three years.
Programme Structure — 12 Months Total
Phase 1 — Total Diet Replacement (TDR)
Phase 2 — Food Reintroduction
Phase 3 — Weight Loss Maintenance
12 weeks of meal replacement products. Medication changes required on day 1 (see below).
Staged return to normal food with dietitian support.
Ongoing coaching to maintain weight loss to 12 months.
Assessment — Eligibility Criteria
Inclusion Criteria — ALL must be met
Patient Factors
- Aged 18–65 years (inclusive)
- Type 2 Diabetes diagnosed within the last 6 years
- BMI ≥27 kg/m² (White ethnic groups) or ≥25 kg/m² (Black, Asian and other ethnic groups)
- Self-measured weight is acceptable; otherwise a clinic value within 12 months if no concern weight has since fallen below threshold
HbA1c & Engagement
- HbA1c within the last 12 months:
- 43–87 mmol/mol if on diabetes medication
- 48–87 mmol/mol if not on diabetes medication
- Recheck first if concern it may have changed
- Attended last offered diabetes review including retinal screening, and commits to continue annual reviews even if remission achieved (newly diagnosed need not wait for first retinal screening)
Exclusion Criteria — do NOT refer if any apply
- Current insulin user
- Unable to stop sulfonylureas, meglitinides, or SGLT2 inhibitors at start of TDR (e.g. SGLT2i prescribed for heart failure or renal protection)
- On the NDDP within the last 12 months (unless referred but never started TDR)
- Pregnant, planning pregnancy within 6 months, or currently breastfeeding
- Significant comorbidity:
- Active cancer
- MI or stroke within the last 6 months
- Severe heart failure (NYHA grade 3–4)
- Severe renal impairment — eGFR <30 mls/min/1.73m²
- Active liver disease other than NAFLD (NAFLD is not an exclusion)
- Active substance use disorder or active eating disorder
- Porphyria
- Untreated proliferative retinopathy
- Previous bariatric surgery, or on the bariatric surgery waiting list
- Assessed as unable to understand or meet the demands/monitoring requirements of the programme
National programme or local service? Refer to the national programme for patients with HbA1c ≤87 mmol/mol, digital literacy, no additional psychological needs, and who value appointment flexibility. Follow local guidance for those needing additional psychological support or with HbA1c >87 mmol/mol.
GLP-1 receptor agonists are not a barrier: patients on GLP-1 analogues (e.g. semaglutide, liraglutide) may continue them during TDR and remain eligible.
Primary Care Management — Medication Changes on Day 1 of TDR
TDR has a profound glucose- and BP-lowering effect, usually greater than any medication. The referrer must plan and agree medication changes with the patient before referral — the SCI Gateway protocol requires confirmation that day-1 changes have been discussed and agreed.
Glucose-Lowering Medication
Current medication
Change required on day 1 of TDR
1–2 oral glucose-lowering medications
Stop all on day 1 of TDR
3 or more oral glucose-lowering medications
Continue metformin, stop all others. If not on metformin, may remain on one of: a DPP-4 inhibitor, pioglitazone, or a GLP-1 analogue
GLP-1 analogues
Safe to continue during TDR if patient or referrer prefers — but only as monotherapy or in combination with metformin
MUST NOT be used during TDR (safety): sulfonylureas (e.g. gliclazide), meglitinides (e.g. repaglinide, nateglinide), and SGLT2 inhibitors (e.g. dapagliflozin, empagliflozin) — hypoglycaemia and euglycaemic DKA risk. Patients who cannot stop these are not eligible.
Antihypertensive Medication
BP control
Change required
Systolic >140 and/or diastolic >90 mmHg
No immediate changes
Systolic <140 and diastolic <90 mmHg
Stop all antihypertensives on day 1 of TDR (postural hypotension risk). Antihypertensives given for indications other than hypertension should be continued. Clinical judgement may retain treatment where necessary.
Why: TDR plus antihypertensives or diuretics can cause postural hypotension with serious consequences. BP commonly rises again when active weight loss ceases — Counterweight monitors weekly and will write to the practice if thresholds are breached.
Monitoring During the Programme
Counterweight monitors blood glucose and blood pressure throughout the programme. If action thresholds are met, they will write to the practice with suggestions for medication titration (reduction, withdrawal, or reintroduction) and ask the patient to contact the practice for review. Any adjustments remain at the GP's clinical judgement — see the Medical Management Guidelines for the full threshold tables.
How to Refer — SCI Gateway
SCI Gateway route: New Message → Referral → Special Health Boards → National Diabetes Programmes → National Type 2 Diabetes Remission Programme → Type 2 Diabetes Remission → Form: "National T2 Diabetes Remission"
Information Needed (mandatory fields)
- Eligibility confirmation (single tick box)
- Date of Type 2 Diabetes diagnosis
- Date and value of latest HbA1c (mmol/mol)
- Ethnicity; interpreter language if relevant
- Weight (kg), height (m), systolic & diastolic BP — check auto-populated values are current
- Current phone number and email address (Counterweight contacts the patient by phone and email)
- Glucose-lowering medication plan (stop / continue metformin ± GLP-1 / etc.)
- Hypertension status and BP medication plan
- Confirmation that day-1 TDR medication changes have been discussed and agreed with the patient (tick box)
Who to Refer
- Aged 18–65 with Type 2 Diabetes diagnosed within 6 years, BMI ≥27 (White) / ≥25 (Black, Asian & other ethnic groups), and HbA1c 43–87 mmol/mol (on medication) or 48–87 mmol/mol (not on medication)
- Motivated, digitally literate patients able to commit to 12 months of app-based remote support
- Patients on metformin or GLP-1 analogues — these can continue during TDR
- Patients with NAFLD — not an exclusion
- Patients on sulfonylureas or SGLT2 inhibitors who can safely stop them on day 1 of TDR
Who Not to Refer
- Insulin users — the programme excludes insulin
- Diagnosis >6 years ago, age outside 18–65, BMI below threshold, or HbA1c >87 mmol/mol (consider local services for HbA1c >87)
- Unable to stop SGLT2 inhibitors (heart failure / renal indication), sulfonylureas, or meglitinides
- Pregnancy, planned pregnancy within 6 months, or breastfeeding
- Active cancer; MI/stroke within 6 months; NYHA 3–4 heart failure; eGFR <30; active liver disease other than NAFLD; porphyria; untreated proliferative retinopathy
- Active eating disorder or substance use disorder
- Previous bariatric surgery or on the waiting list
- On the programme within the last 12 months (unless never started TDR)
- Needing significant psychological support alongside weight management — follow local guidance instead
- Unable to tolerate meal replacements or engage with app-based monitoring — signpost to alternative weight management pathways
References & Resources
- Counterweight NHS Scotland referrer page (toolkit: one-page guide, eligibility criteria, pre-referral guide, medication guidelines, patient information): counterweight.org — NHS Scotland referrers
- Patient Eligibility Criteria (PDF)
- Medical Management Guidelines 2026 (PDF) — full medication adjustment and threshold tables
- How to Make a Referral — SCI Gateway guide (PDF)
- Patient Information Sheet (PDF)
- Lean MEJ et al. DiRECT 2-year results. Lancet Diabetes Endocrinol 2019
- Valabhji J et al. Early findings from the NHS Type 2 Diabetes Path to Remission Programme. Lancet Diabetes Endocrinol 2024;12(9):653–663
- NICE NG28 — Type 2 Diabetes in Adults (2022); SIGN 154 — Management of Diabetes
Last reviewed: July 2026 | DGRefHelp — NHS Dumfries & Galloway. Source: Counterweight NHS Scotland referrer toolkit (2026 documents). Confirm current criteria via the links above before referral, as provider documents may be updated.