New remission care pathway: Diabetes Adaptive Weight management Network "NewDAWN"

Research question Can a new care pathway, offering support for a sequence of NHS weight-loss programmes lead to a higher proportion of people with overweight and newly diagnosed type 2 diabetes (T2D) achieving remission compared with a total diet replacement programme? Background Weight loss can help people who are overweight and recently diagnosed with T2D to achieve remission. Total diet replacement (TDR) programmes are being offered by the NHS but are only suitable for a small proportion of patients. The challenge is to offer a care pathway which supports the varied needs of individual patients so they can each lose as much weight as possible, maximising the population achieving remission. Aims and Objectives The aim is to develop and test whether offering a structured programme with the opportunity to self-experiment with several weight loss programmes: increases the likelihood of people with newly diagnosed T2D who are overweight achieving remission compared with the current best NHS treatment is cost effective for the NHS can be implemented in routine care Methods We will develop the new pathway by reviewing interventions available within the NHS and conducting qualitative research involving people with lived experience of T2D and weight loss attempts, followed by a discrete choice experiment to understand the factors affecting patient preferences. Working with stakeholders and patients, we will use the findings to co-create a new care pathway which allows patients for whom TDR is unsuccessful or unwanted to follow a programme of guided self-experimentation until they find a programme that works for them. We will test the new pathway, against TDR alone (current best care), in a feasibility trial (n=150), assessing feasibility of implementation of the self-experimentation pathway, effectiveness of training for practitioners and the acceptability to patients. We will progressively optimise the intervention. If the trial meets pre-specified criteria, we will proceed to a full trial (n=1788) to test whether the new pathway can increase the rate of remission of T2D compared with referral to a TDR programme. We will measure the effect of the intervention on cardiovascular risk and quality of life and assess the cost-effectiveness of the intervention compared to TDR through modelling. Building on theory-based process evaluation and coproduction with stakeholders, we will prepare materials and identify practices to support implementation. Timelines for delivery We will develop the new care pathway in the first year, conduct feasibility testing and improve the intervention (13-24m), set up and conduct the main trial and process evaluation (24-40m), complete follow-up by 52m, analyse the outcomes, estimate the cost-effectiveness, disseminate the results and, if successful, work with NHSE to embed the pathway in their diabetes programme by end of year 5. Anticipated Impact and Dissemination Our patient advisory group wanted to know about a range of ways to achieve remission and this programme seeks to meet this need. If successful, we will work closely with our patient advisory groups, Diabetes UK, NHSE and other stakeholders to disseminate and implement this new pathway so more people with T2D achieve remission.