Total diet replacement: a cost-effective contribution to the fight against type 2 diabetes

Posted On: 23rd August 2022

Diabetes is among the main public health challenges that Europe is facing today. According to the International Diabetes Federation (IDF), in Europe an estimated 61 million adults were living with diabetes in 2021. The IDF projects that diabetes prevalence will increase to 13% of the adult population by 2045.

A recent blog post by the European Federation of Pharmaceutical Industries and Associations emphasised that timely prevention and effective treatment are key to addressing type 2 diabetes (T2DM) and stressed the impact of this health condition on the European economy. The author emphasised the importance of the primary care sector in addressing diabetes but gave no clues as to what needed to be done, other than provide more staff, training and resources. As policy makers, healthcare professionals and other stakeholders are looking at how best to tackle T2DM, it is crucial to explore all options available.

Obesity and overweight are the leading risk factors for T2DM, and there is an increasing evidence base within scientific literature showing that weight reduction is the most important component of T2DM prevention, along with increased physical activity and optimal composition of the maintenance diet. While lifestyle and conventional diet changes or, in the more severe cases, bariatric surgery can support weight loss and maintenance, it is important that other options are also reviewed.

Total diet replacements (TDRs) provide safe and effective weight loss for people living with obesity and overweight. TDMR Europe, the trade body representing the sector, has recently organised two educational events to review the latest research on obesity and T2DM.

The online seminars “Diabetes Remission: Maintenance after weight loss with TDR” and “TDR: exploring sustainable weight loss and health benefits, including diabetes remission and prevention” highlighted how weight loss with TDR can help improve and T2DM put into remission. In addition, the webinars showed that TDR provides a cost-effective contribution to the fight against this public health issue, which is important at a time when healthcare service resources are increasingly under pressure.

Experts who spoke at the events explained that the PREVIEW trial provided strong evidence for the use of an initial weight loss with TDR as the first stage of a diabetes prevention programme. All diabetes prevention programmes have shown that the greater the initial weight loss and subsequent weight loss maintained then the smaller the number of people who develop diabletes. In PREVIEW TDR delivered an average 10.3 kg weight loss in 8 weeks. Similarly, the DiRECT study, undertaken in a primary care setting, saw almost half of those who went on a low-calorie diet with TDR achieve remission of their T2DM after one year. A quarter of participants achieved a 15kg or more weight loss, and of these, 86% put their T2DM into remission. A more recent trial that used TDR, called DROPLET and also undertaken in a primary care setting, has demonstrated similar weight loss in people with obesity.

The NHS soups and shakes diet programme which provides a weight loss programme with TDR for people with obesity and T2DM was based on the DiRECT and DROPLET studies. According to the latest data published by NHS, over 2,000 people with T2DM have now improved their health through the soups and shakes diet programme with participants losing an average of 13kg in three months. Following this successful outcome, the NHS has recently expanded its programme which is now available in 11 more regions across England.

Diabetes UK, a leading charity, estimates that by 2030 5.5 million people in the UK will have diabetes, a disease that costs NHS £10 billion a year. With its soups and shakes diet programme the NHS England together with the NHS Scotland, has set the example for European public health authorities on how to help individuals with obesity and T2DM improve their health in a primary care setting as well as on how to reduce health-care expenditure related to these health conditions.


Primary health care is key to solving the diabetes challenge (Guest blog)

For further information on the DiRECT trial click here.

More information on the PREVIEW study is available here.

Find out more about the DROPLET trial here.


Aristeidis Myriskos, TDMR Europe Secretariat​