Type 2 remission service in Scotland

The DIRECT study - one of the biggest research studies into type 2 remission showed that a low-calorie weight management programme offers most people living with type 2 diabetes the best chance putting their diabetes into remission. In Scotland, the Healthier Future framework recommends type 2 diabetes programmes specifically designed to help people living with type 2 diabetes and obesity or overweight to try going into remission.

In Scotland, many health boards offer remission weight management programmes. These low-calorie weight management programmes are more than just a diet. They are specifically designed to help people put their blood sugar levels into a non-diabetes range long-term, without the need for diabetes medication.

A team of specialists support you to lose weight quickly and safely through a low-calorie diet and then help you to maintain the weight loss. They’ll give you personalised advice on food, physical activity, and wellbeing. And you’ll learn what the best way is to eat and move for you, to help put your type 2 remission for as long as possible.

Counterweight Plus® is the most common remission weight management programme in Scotland. It is based on the DiRECT study and aims to help you to lose a significant amount of weight quickly and safely, to help put your blood sugar levels below a diabetes range and keep them there long-term.

You can be referred through your GP or healthcare team, or, depending on your health board, you can put yourself forward for the programme through a self-referral.

Is a remission weight management programme right for me?

There are certain criteria that you need to meet to be eligible for a remission weight-loss programme. Ask your healthcare professional if you meet the criteria for entry to a remission programme. These criteria are likely to include:

1. You have been diagnosed with type 2 diabetes in last 6 years
2. You are 18-65 years old
3. Your BMI is 27 or above - for white Caucasians. OR 25 or above for people from South East Asian, African-Caribbean or Black African backgrounds.
4. Your HbA1c at your last check within 12 months was above 48 mmol/mol if you are not taking diabetes medication; OR above 43 mmol/mol if taking diabetes medication

How Counterweight Plus® and other remission weight loss programmes work

Remission weight management programme - e.g. Counterweight Plus® - are 12-month long programmes made up of three steps. You get specialist support from a healthcare team every step of the way. This team can include GPs, diabetes specialists, dietitians, health psychologists, and exercise specialists.

Step 1: Replace all food with soups and shakes

For the first 12 weeks you will replace all meals with low-calorie soups and shakes. This is called a total diet replacement plan. You replace all your ordinary meals with total diet replacement products, including soups and shakes. The soups and shakes will make up around 800-900 calories a day and provide all the nutrients your body needs.

Step 2: Reintroduce healthy meals of around 1200 calories a day.

After the 12 weeks ‘soups and shakes’, you’ll slowly reintroduce nutritious food into your diet. This step lasts around 6 weeks. Your healthcare team will give you personalised advice and meal plans to ensure your diet is healthy, well balanced and supports your weight loss journey. You’ll also be supported to increase your physical activity levels, to help improve your all-round health.

Step 3: Weight Maintenance

By this stage of the programme, many people have found they have lost weight and are already seeing benefits. People tell us they have more energy and find it easier to move around, whether that’s going up the stairs or when exercising. The next step is to keep off the weight you’ve lost during the programme. You’ll learn more about building activity into your lifestyle, how to get a good night’s sleep, how to deal with stress, how to build positive habits, and what to do if you find you are regaining the weight you have lost.