Glucose Lowering through Weight management (GLoW): a randomised controlled trial of the clinical and cost effectiveness of a diabetes education and behavioural weight management programme vs a diabetes education programme in adults with a recent diagnosis of type 2 diabetes.
Diabetologia 2025
Mueller J, Breeze P, Fusco F, Sharp SJ, Pidd K, Brennan A, Hill AJ, Morris S, Hughes CA, Bates SE, Pollard D, Woolston J, Lachassseigne E, Stubbings M, Whittle F, Jones RA, Boothby CE, Duschinsky R, Bostock J, Islam N, Griffin SJ, Ahern AL, Ahern A
DOI : 10.1007/s00125-024-06355-6
PubMed ID : 39849151
PMCID :
URL : https://link.springer.com/article/10.1007/s00125-024-06355-6
Abstract
UK standard care for type 2 diabetes is structured diabetes education, with no effects on HbA, small, short-term effects on weight and low uptake. We evaluated whether remotely delivered tailored diabetes education combined with commercial behavioural weight management is cost-effective compared with current standard care in helping people with type 2 diabetes to lower their blood glucose, lose weight, achieve remission and improve cardiovascular risk factors.
We conducted a pragmatic, randomised, parallel two-group trial. Participants were adults (≥18 years) with overweight or obesity (BMI≥25 kg/m) and recently diagnosed with type 2 diabetes (≤3 years), recruited from 159 primary care practices in England. We randomised participants to a tailored diabetes education and behavioural weight management programme (DEW; delivered by Weight Watchers) or to current standard care diabetes education (DE; Diabetes Education and Self Management for Ongoing and Newly Diagnosed [DESMOND] programme), using a computer-generated randomisation sequence in a 1:1 allocation stratified by gender and diabetes duration, unknown to those collecting and analysing the data. Participants could not be blinded due to the nature of the interventions. Participants completed assessments at 0, 6 and 12 months. The primary outcome was 12 month change from baseline in HbA. We also assessed bodyweight, blood pressure, cholesterol (total, HDL, LDL), glucose-lowering medication, behavioural measures (physical activity, food intake), psychosocial measures (eating behaviour, diabetes-related quality of life, wellbeing) and within-trial and modelled lifetime cost effectiveness.
We randomised 577 participants (DEW: 289, DE: 288); 398 (69%) completed 12 month follow-up. We found no evidence for an intervention effect on change in HbA from baseline to 12 months (difference: -0.84 [95% CI -2.99, 1.31] mmol/mol, p=0.44) or 6 months (-1.83 [-4.05, 0.40] mmol/mol). We found an intervention effect on weight at 6 (-1.77 [-2.86, -0.67] kg) and 12 months (-1.38 [-2.56, -0.19] kg). Participants in DEW had a higher likelihood of achieving diabetes remission than participants in DE (6 months: RR 2.10 [95% CI 1.03, 4.47]; 12 months: RR 2.53 [1.30, 5.16]). DEW was cost-effective compared with DE in within-trial and lifetime analyses, in the latter generating an incremental cost effectiveness ratio of £2290 per quality-adjusted life year gained.
A commercial behavioural weight management programme combined with remote dietary counselling after diagnosis of type 2 diabetes did not improve HbA up to 12 months post intervention in this trial. The intervention could help people achieve weight loss and be cost-effective compared with current standard National Health Service care.
ISRCTN 18399564 FUNDING: National Institute for Health and Care Research (NIHR; RP-PG-0216-20010), Medical Research Council (MC_UU_00006/6), NIHR Cambridge Biomedical Research Centre (NIHR203312).
Lay Summary
Why is this study important?
Losing weight can help people living with type 2 diabetes to improve their average blood sugar (“HbA1c”) and reduce their risk for heart disease. Previous studies have shown that “formula diets” (which completely replace all meals with a very low calorie formula) can help people lose a substantial amount of weight, but these programmes are expensive and might not be acceptable or suitable for everyone.
Behavioural weight management programmes aim to help people lose weight by changing their behavior, for example by improving their diet or exercising more. Such programmes can help people lose weight. At the moment most people with type 2 diabetes in the UK get education about diabetes but there is no evidence that this really helps either with blood sugar or long-term weight loss.
What was our aim?
The aim of our study was to find out whether a new programme combining diabetes education with behavioural weight management would help people with a recent diagnosis of type 2 diabetes to lower their average blood sugar, lose weight, achieve remission, and improve cardiovascular risk. We aimed to compare this new programme with the “standard care” that people with type 2 diabetes currently get in the UK. We also aimed to examine whether this new programme is good value for money.
What did we do?
We recruited 577 adults living with overweight or obesity who had been diagnosed with type 2 diabetes within the past 3 years. We randomly allocated study participants to one of two groups:
• People in the intervention group were given access to the “Live Well With Diabetes” programme. They received two telephone calls from a registered dietitian, and 6 months’ access to WW (formerly Weight Watchers), a behavioural programme which involves weekly group meetings and digital resources like the WW app.
• People in the standard care group received access to “DESMOND”, a diabetes education workshop which takes place over 6 hours and is led by a registered dietitian.
We measured average blood sugar, weight, other medical tests (like cholesterol), and self-reported questionnaires (on eating behaviour, diabetes-related quality of life, and wellbeing) at the start of the study, at 6 months and at 12 months.
What did we find?
The change in average blood sugar from the start of the study to 12 months later was similar in the two groups. The intervention group lost 1.97 kg more weight at 6 months and 1.46 kg more weight at 12 months than the standard care group. Adults in the intervention group were more than twice as likely to achieve “diabetes remission” at 6 and 12 months as those receiving standard care. “Remission” was defined as having an average blood glucose level lower than 48mmol/mol without being prescribed diabetes mediation.
What’s the take-home message?
The tailored diabetes education and behavioural weight management programme (= the intervention) did not improve average blood sugar compared to the standard care diabetes education, but it did help people lose more weight and achieve diabetes remission.
The tailored diabetes education and weight management programme was more expensive than current standard care. However, when we looked at the impact of the intervention on health and health care costs over a lifetime, we showed that investing in the more expensive programme would be better value for money.