Low-Calorie Diet (LCD) Programme for Type 2 Diabetes


Low-Calorie Diet (LCD) Programme for Type 2 Diabetes

The low-calorie diet service launched nationally in September 2020, as part of a two-year pilot programme. The launch began with ten sites across England, including NEL, and an additional eleven sites were added in January 2022. Five hundred patient places are available across NEL.

The NEL service, offered by Xyla Health and Wellbeing, provides a group based face to face one-year programme currently being delivered virtually, 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 details of the studies can be found using the links below.

Programme overview

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  

NEL Pilot Overview
Currently, Xyla is accepting eligible referrals from all practices in Tower Hamlets, Newham, Waltham Forest, Barking & Dagenham, Havering and Redbridge. In City and Hackney the pilot is open across three PCNs including – Hackney Marshes PCN, Clissold Park PCN and London Fields PCN.

The pilot is funded by NHSE and each accepted eligible referral will be remunerated £75 which is intended to cover identification, reviews, referral and ongoing management of the patient. Accepted referral equates Milestone 1(M1) – which is when a referred patient is booked onto the programme by Xyla, attends the initial assessment and attends first group session.

Further, Eligible NHS Low Calorie Diet Programme referrals (from GP practices in current pilot sites can attract the Weight Management Enhanced Service payment, where applicable (a BMI of ≥ 30 (≥ 27.5 for Black, Asian and other minority ethnic groups). 

For any queries regarding payment please contact nelondonicb.stpdiabetes@nhs.net.

How to refer

  • Referrals are made by a trained health care professional via the GP surgery.
  • Referral methods include email or EMIS managed referral.

Low-calorie diet eligibility searches are available on practice clinical systems to support identification of appropriate patients but search patient eligibility needs to be reviewed on a case by case basis. All patients referred must be motivated and committed to taking part in the 12-month programme. Please see downloads section to screenshot of where to find the LCD search.

To reduce workload on individual practices, PCNs 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 or there may be a focus on referring patients newly diagnosed with Type 2 diabetes.

After discussing the service with your patient and confirming eligibility for the pathway, complete the NHS Low Calorie Diet Referral and email to Scwcsu.nellcd@nhs.net.  

Please note, patients must be given a copy of their medication change letter in order to be accepted for an initial assessment by the provider.

 Resources include:

Related downloads:

  • Training Slides – TNW
  • LCD EMIS search location
  • NEL National communications pack
  • Training Slides – BHR
  • Training Slides – CH
  • Patient Information Leaflet – English and Urdu
  • NEL Case Study: Imtiaz’s Low Calorie Diet Journey
  • Previous progress updates from Xyla
  • NEL LCD Oct 2021 Newsletter

Eligibility criteria

Inclusions

  • 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

Exclusions

  • 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)

External Links

Who Can I contact for more information?

Please email any generic or payment related queries to: nelondonicb.stpdiabetes@nhs.net.

Please email any service specific or training queries to: Komal Tobani, NEL Contract Liaison Officer, komal.tabani@xylahealth.com

Provided By

Related Services across North East London

Digital Weight Management Programme - linked

National Diabetes Prevention Programme - linked