{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:12:38Z","timestamp":1792019558799,"version":"4.4.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["RP-PG-0216-20010"],"award-info":[{"award-number":["RP-PG-0216-20010"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018956","name":"NIHR Cambridge Biomedical Research Centre","doi-asserted-by":"publisher","award":["NIHR203312"],"award-info":[{"award-number":["NIHR203312"]}],"id":[{"id":"10.13039\/501100018956","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MC_UU_00006\/6"],"award-info":[{"award-number":["MC_UU_00006\/6"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Diabetologia"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Aims\/hypothesis<\/jats:title>\n            <jats:p>UK standard care for type 2 diabetes is structured diabetes education, with no effects on HbA<jats:sub>1c<\/jats:sub>, 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We conducted a pragmatic, randomised, parallel two-group trial. Participants were adults (\u226518 years) with overweight or obesity (BMI\u226525 kg\/m<jats:sup>2<\/jats:sup>) and recently diagnosed with type 2 diabetes (\u22643 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<jats:sub>1c<\/jats:sub>. 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>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<jats:sub>1c<\/jats:sub> from baseline to 12 months (difference: \u22120.84 [95% CI \u22122.99, 1.31] mmol\/mol, <jats:italic>p<\/jats:italic>=0.44) or 6 months (\u22121.83 [\u22124.05, 0.40] mmol\/mol). We found an intervention effect on weight at 6 (\u22121.77 [\u22122.86, \u22120.67] kg) and 12 months (\u22121.38 [\u22122.56, \u22120.19] 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 \u00a32290 per quality-adjusted life year gained.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\/interpretation<\/jats:title>\n            <jats:p>A commercial behavioural weight management programme combined with remote dietary counselling after diagnosis of type 2 diabetes did not improve HbA<jats:sub>1c<\/jats:sub> 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration<\/jats:title>\n            <jats:p>ISRCTN 18399564<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Funding<\/jats:title>\n            <jats:p>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).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          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BMJ Open 13(3):e067607. https:\/\/doi.org\/10.1136\/BMJOPEN-2022-067607","journal-title":"BMJ Open"}],"container-title":["Diabetologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-024-06355-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00125-024-06355-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-024-06355-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T08:15:24Z","timestamp":1745482524000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00125-024-06355-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,23]]},"references-count":32,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["6355"],"URL":"https:\/\/doi.org\/10.1007\/s00125-024-06355-6","relation":{},"ISSN":["0012-186X","1432-0428"],"issn-type":[{"value":"0012-186X","type":"print"},{"value":"1432-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,23]]},"assertion":[{"value":"18 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"We thank all staff from the MRC Epidemiology Unit Functional Group Team, particularly with regard to study coordination, anthropometry measurement, physical activity measurement, laboratory sample collection and analysis, data management, IT, business operations and research governance. We thank NIHR CRN Eastern Primary Care research delivery colleagues, regional primary care stakeholders and Cambridgeshire and Peterborough CCG Research Team for their input to the protocol and operational aspects of the study. Thank you for the support of our Trial Steering Committee (L. Yardley, A. Farmer, E. Doherty, T. Fanshawe, G. Rhodes, H. Patel and N. Scullion). We would also like to thank our patient user panel (F. Amrani, H. Anderson, R. Bentley, R. Clifton, T. Morris, G. Pountain, I. Smith, N. Timmings, M. Willis) for all their input to the trial, and also all the GLoW participants for taking part. WW provided the intervention for this trial at no cost but had no role in the design, data collection, data analysis, data interpretation or writing of the report. Some of the data were presented as an abstract at the 52nd Annual Scientific Meeting of the SAPC, Bristol, July 2024, at Obesity Week in Dallas, November 2023, and at the Diabetes UK Professional Conference in London, April 2024.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Acknowledgements"}},{"value":"The dataset analysed during the current study is not publicly available. Participant consent allows for data to be shared in future analyses with appropriate ethical approval, and the host institution has an access policy () so that interested parties can obtain the data for replication or other research purposes that are ethically approved. Data access is available upon reasonable request (datasharing@mrc-epid.cam.ac.uk) and the data dictionary is available at . Study documents (study protocol, statistical analysis plan, informed consent form, participant information sheet, analytic code) are available at  or on request. The fully executable code, simulated individuals and simulated parameters used to conduct the economic analyses are available under a GPL version 2 or later licence at:","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"This work was supported by the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research Programme (RP-PG-0216-20010), the Medical Research Council (MC_UU_00006\/6) and the NIHR Cambridge Biomedical Research Centre (NIHR203312). The views expressed are those of the authors and not necessarily those of the MRC, NIHR or the Department of Health and Social Care. The University of Cambridge has received salary support in respect of SJG from the NHS in the East of England through the Clinical Academic Reserve. The funders of the study had no role in the design, data collection, data analysis, data interpretation, or writing of the report.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: FF, FW, PB, KP, JW, EL, MS, RD, SJS, SM, NI, SEB, CEB, NI, AB and JB declare that there are no relationships or activities that might bias, or be perceived to bias, their work. AJH has consulted for Slimming World UK. CAH reports consulting fees, payment or honoraria or support for attending meetings and\/or travel from Ethicon and Novo Nordisk. JM is a former Trustee and current member of the Operations Committee for the Association of the Study of Obesity (unpaid role) and has organised educational events funded by Boehringer Ingelheim Ltd and Rhythm Pharmaceuticals. Since the completion of the trial analyses, RAJ has commenced employment for WW. ALA is a member of the Scientific Advisory Board for WW (payment to institution). SJG has received honoraria from Astra Zeneca and Eli Lilly for contributing to postgraduate educational meetings and is a Trustee for the Novo Nordisk UK Research Foundation. DP worked on the Hypo-RESOLVE project, which received in kind support from Novo Nordisk, Eli Lilly, Sanofi, Abbott and Medtronic, and has received personal payments from Novo Nordisk.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors' relationships and activities"}},{"value":"ALA led the conceptualisation and design of the study, led funding acquisition and is the principal investigator of the trial. SJG is joint principal investigator and contributed to the conceptualisation and design of the study and co-led funding acquisition. AJH, CAH, PB, SM, AB and RD are co-investigators on the trial and contributed to study design and conceptualisation and funding acquisition. JM, PB, KP, FF and SM performed the data analyses. JM, PB, ALA, SM and FF wrote the first draft of the manuscript. FW, RAJ, JW, EL and MS were responsible for trial operations and management. SJS supervised the data analysis (clinical effectiveness). NI contributed to the analysis and interpretation of data. JB chaired the Patient and Public Involvement group. SEB and DP contributed to code development and development of the analysis plan for the lifetime cost effectiveness analysis. CEB was responsible for data curation and management. All authors provided critical review for intellectual content before submission and approved the final manuscript. ALA is the guarantor.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}