Milestones DM2: a digitally-enabled clinical weight management programme for people with type 2 diabetes (TDM2) + BMI >30kg/m2 (#2499)

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Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
Milestones DM2 combines nutritional and digital innovation to help people with T2DM lose at least 15kg of bodyweight, which will improve diabetes treatment targets, reduce complication rates and generate NHS cost-savings.
Overview of Innovation:
The challenge:
Diabetes costs the NHS £10 billion a year, approximately 10% of the entire NHS budget, much of which is spent treating complications that can be prevented through good diabetes control defined as achieving ‘treatment targets’ in blood glucose (HbA1c), blood pressure & cholesterol. Most T2DM patients do not achieve these targets, but weight loss can help.

NICE recommends T2DM patients with a BMI over 30kg/m2 be considered for bariatric surgery & that all patients referred to bariatric surgery enter a tier 3 weight management service to attempt medical management. However, provision of such services is variable & existing services are limited in accessibility & cost-effectiveness.



Our solution:
Milestones DM2 provides an effective alternative to traditional services utilising digital technology for a remote, high-frequency, multi-disciplinary service via initial face to face then phone calls, online learning and a smartphone app. This ensures lower delivery costs by not requiring continuous face-to-face clinics, increased accessibility and improved effectiveness as patients are provided with the high frequency support shown in clinical trials to be superior to low frequency care.

Milestones DM2 builds on evidence which has shown a medical weight loss programme using 8-12 weeks of 800kcal total diet replacement (TDR) followed by supported food reintroduction can achieve 15kg bodyweight loss, with 60% of those with T2DM for <4 years reducing and maintaining their HbA1c to <48mmol/mol at 9 months. **

As such, Milestones DM2 is delivered over 12 months by a remote multidisciplinary team (MDT) of diabetes specialist dietitians and nurses, along with psychologists, exercise therapists and endocrinologists.

The patient journey in 3 phases:

1. Eight weeks of an 800 kcal TDR (OPTIFAST® from Nestlé Health Science). Note that the option of intermittent TDR (2 days/week for 27 weeks) is available for those who cannot tolerate continious TDR (7 days/week for 8 weeks)
2. Four weeks supported food reintroduction
3. Nine months of maintenance



Patients receive weekly healthcare professional support throughout Phases 1 & 2 and then monthly during Phase 3. This is provided via phone calls and/or text and video support via the Milestones DM2 smartphone app (which can also be used for self-monitoring). The technology enabling remote care for Milestones DM2 is provided by Oviva UK Ltd, an SME focused on provision of digitally enabled dietetic services across 17 NHS CCGs.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
Similar Content3
Innovation 'Elevator Pitch':
Oviva Diabetes Support and Prevention are QISMET-accredited education and behavioural change interventions for people with or at risk of type 2 diabetes, which have demonstrated signficant improvements in uptake and clinical outcomes.
Overview of Innovation:
Oviva’s services for people with or at risk of type 2 diabetes are now available in 18 CCGs across England, and have demonstrated improved uptake and outcomes in comparison with traditional models of care. 

Oviva services offer accessible, evidence-based, personalised care 
All Oviva services combine:
  • High-frequency, 1-to-1 coaching from a diabetes specialist dietitian to drive behaviour change and tackle psychological barriers, delivered over the telephone or using the Oviva app.
  • Supporting materials for participants to access in their own time, including videos, podcasts, and written guides, which explain more about type 2 diabetes. Participants retain access to resources for life, and they are available online or as hard copy booklet and/or DVD. All Oviva resources reflect NICE and NHS guidelines and are reviewed by a clinical advisory board regularly.
  • Optional use of the Oviva smartphone app, which participants can use to maintain a food diary and access learning resources. This app links to the dietitian’s electronic patient record to enable the dietitian to provide feedback. 
  • Activation call from Oviva patient pathway coordinators, who are trained in motivational interviewing and focused on driving uptake.
This approach is tailored to meet the needs of different patient cohorts, as described below. 

Oviva Diabetes Prevention: an 8 week intensive education and behaviour change programme with follow up care at 3, 6 and 12 months, focused on weight loss and reducing HbA1c levels (for patients with non-diabetic hyperglycaemia). This service has recently been adopted as part of the NHS Diabetes Prevention Programme in England, and real world data will be available for analysis soon.

Oviva Diabetes Support: an 8 - 10 week QISMET-accredited structured education and behaviour change programme, focused on supporting patients to meet diabetes treatment targets, lose weight, and develop sustainable self-management skills. Real world data demonstrates an average HbA1c reduction of 13mmol/mol at 6 months, weight loss of -4.5%, whilst patients report that their average confidence in managing their diabetes increased from 4/10 to 8/10 (clinical outcomes from 85 patients). Uptake in 1453 referrals is c.70%, compared with c.30% in traditional models. 

Oviva Diabetes Support has now been selected by NHS England to join the NHS Innovation Accelerator and the Digital Diabetes Coach Test Bed. 

To view our Information Pack - click here.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Innovation and adoption / Person centred care
Benefit to NHS:
Oviva Diabetes Support and Prevention benefit the NHS by widening access to effective care, and generating improved patient outcomes for people with or at risk of type 2 diabetes. In turn, this drives efficiency savings in terms of avoiding preventable utilisation of services in primary and secondary care, along with medications and treatment costs associated with disease progression and diabetes complications. 

As described in the overview, service uptake is c.71%. By contrast, the National Diabetes Audit indicates that uptake of structured education for people newly diagnosed with type 2 diabetes is c.7.4% (2.9% in the West Midlands), and uptake of the National Diabetes Prevention Programme is 49%. Increased accessibility and flexibility enables people unable or unwilling to access traditional face-to-face courses, along with supporting commissioners and clinicians to meet targets associated with attendance at diabetes structured education included in the NHS Improvement and Assessment Framework and Quality and Outcomes Framework.

Moreover, real world data (85 Oviva Diabetes Support patients) demonstates an average HbA1c reduction at c.6 months of 13mmol/mol, and bodyweight loss of 4.5%, supporting the achievement of diabetes treatment targets (also included in the Improvement and Assessment Framework and Quality and Outcomes Framework). 

These clinical outcomes can drive a return on investment for CCGs; Frontier Economics modelling indicates that based on existing clinical outcome data, provision of Oviva Diabetes Support for 500 participants achieves £219k of year 1 savings, rising to £550k by year 5. This is comprised of avoidance of 72 admissions, 100 outpatient and 280 GP visits, along with avoidance of more than £17k of prescribing costs. Targeting the service at patients receiving or likely to need high cost medications (including insulin, SGLT-2, and GLP-1) could drive additional savings of more than £800 per participant per year. 

Oviva Diabetes Support and Prevention also offer commissioners a 'payment by engagement' cost model, ensuring that commissioners only fund the service for active participants. This contrasts with the block contract model of traditional face-to-face group courses, which offers commissioners limited recourse to challenge poor uptake locally.  
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
By providing an accessible, flexible and effective approach to improving outcomes for people with type 2 diabetes Oviva Diabetes Support and Prevention can impact on the WM population (7.7% of whom have type 2 diabetes, and 11% of whom are likely to be at risk) beyond the local health economy by:
  • Reducing the need for people with or at risk of type 2 diabetes requiring time away from work to attend education courses or future appointments associated with the treatment of complications, thus contributing to maintaining productivity and the local economy.
  • Providing participants with personalised and remote care widens access to cohorts identified as less likely to attend traditional programmes, such as working age men, BME groups, or rural communities, particularly essential in diverse populations such as the West Midlands. Evidence of accessibility can be seen in the success of Oviva Diabetes Support in areas such as London and Devon.   
  • Reducing the impact on the environment associated with delivery of traditional models of care, which drives a number of journeys for patients and staff and the environmental costs associated with physical premises.
  • Improving outcomes enables people with type 2 diabetes to remain in work; Diabetes UK has estimated that the costs of reduced productivity at work due to people with diabetes not working because of death or poor health, or working at a lower level of productivity are estimated at nearly £9 billion.  
Current and planned activity: 
Oviva Diabetes Support is currently in pilot or commissioned in the following areas: North West London collaborative of CCGs, South West London collaborative, NEW Devon CCG, Chiltern and Aylesbury Vale CCGs, Swindon CCG, Somerset CCG, Leicester, Leicestershire and Rutland CCGs, and Salford CCG. Oviva Diabetes Support will soon be available to self-referral nationally as part of the Diabetes Digital Coach Test Bed. Oviva Diabetes Support is supported through NHS England through the NHS Innovation Accelerator, and has been rewarded a research grant via Innovate UK and the digital health catalyst to evaluate our clinical outcomes with King's College London. 

Oviva Diabetes Prevention is part of the NHS England Healthier You - Diabetes Prevention Programme digital stream, recently launching in North West London, Somerset, and Chiltern and Aylesbury Vale CCGs. 

Oviva is keen to explore opportunities for adoption of our service in the West Midlands. 
What is the intellectual property status of your innovation?:
All intellectual property is owned by Oviva. 
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
Read more
Hide details
Innovation 'Elevator Pitch':
Oviva Diabetes Support and Prevention are QISMET-accredited education and behavioural change interventions for people with or at risk of type 2 diabetes, which have demonstrated signficant improvements in uptake and clinical outcomes.
Overview of Innovation:
Oviva’s services for people with or at risk of type 2 diabetes are now available in 18 CCGs across England, and have demonstrated improved uptake and outcomes in comparison with traditional models of care.

Oviva services offer accessible, evidence-based, personalised care
All Oviva services combine:
  • High-frequency, 1-to-1 coaching from a diabetes specialist dietitian to drive behaviour change and tackle psychological barriers, delivered over the telephone or using the Oviva app.
  • Supporting materials for participants to access in their own time, including videos, podcasts, and written guides, which explain more about type 2 diabetes. Participants retain access to resources for life, and they are available online or as hard copy booklet and/or DVD. All Oviva resources reflect NICE and NHS guidelines and are reviewed by a clinical advisory board regularly.
  • Optional use of the Oviva smartphone app, which participants can use to maintain a food diary and access learning resources. This app links to the dietitian’s electronic patient record to enable the dietitian to provide feedback.
  • Activation call from Oviva patient pathway coordinators, who are trained in motivational interviewing and focused on driving uptake.
This approach is tailored to meet the needs of different patient cohorts, as described below.

Oviva Diabetes Prevention: an 8 week intensive education and behaviour change programme with follow up care at 3, 6 and 12 months, focused on weight loss and reducing HbA1c levels (for patients with non-diabetic hyperglycaemia). This service has recently been adopted as part of the NHS Diabetes Prevention Programme in England, and real world data will be available for analysis soon.

Oviva Diabetes Support: an 8 - 10 week QISMET-accredited structured education and behaviour change programme, focused on supporting patients to meet diabetes treatment targets, lose weight, and develop sustainable self-management skills. Real world data demonstrates an average HbA1c reduction of 13mmol/mol at 6 months, weight loss of -4.5%, whilst patients report that their average confidence in managing their diabetes increased from 4/10 to 8/10 (clinical outcomes from 85 patients). Uptake in 1453 referrals is c.70%, compared with c.30% in traditional models.

Oviva Diabetes Support has now been selected by NHS England to join the NHS Innovation Accelerator and the Digital Diabetes Coach Test Bed.

To view our Information Pack - click here.
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
WMAHSN priorities and themes addressed: 
Long term conditions: a whole system, person-centred approach
Benefit to NHS:
Oviva Diabetes Support and Prevention benefit the NHS by widening access to effective care, and generating improved patient outcomes for people with or at risk of type 2 diabetes. In turn, this drives efficiency savings in terms of avoiding preventable utilisation of services in primary and secondary care, along with medications and treatment costs associated with disease progression and diabetes complications.

As described in the overview, service uptake is c.71%. By contrast, the National Diabetes Audit indicates that uptake of structured education for people newly diagnosed with type 2 diabetes is c.7.4% (2.9% in the West Midlands), and uptake of the National Diabetes Prevention Programme is 49%. Increased accessibility and flexibility enables people unable or unwilling to access traditional face-to-face courses, along with supporting commissioners and clinicians to meet targets associated with attendance at diabetes structured education included in the NHS Improvement and Assessment Framework and Quality and Outcomes Framework.

Moreover, real world data (85 Oviva Diabetes Support patients) demonstates an average HbA1c reduction at c.6 months of 13mmol/mol, and bodyweight loss of 4.5%, supporting the achievement of diabetes treatment targets (also included in the Improvement and Assessment Framework and Quality and Outcomes Framework).

These clinical outcomes can drive a return on investment for CCGs; Frontier Economics modelling indicates that based on existing clinical outcome data, provision of Oviva Diabetes Support for 500 participants achieves £219k of year 1 savings, rising to £550k by year 5. This is comprised of avoidance of 72 admissions, 100 outpatient and 280 GP visits, along with avoidance of more than £17k of prescribing costs. Targeting the service at patients receiving or likely to need high cost medications (including insulin, SGLT-2, and GLP-1) could drive additional savings of more than £800 per participant per year.

Oviva Diabetes Support and Prevention also offer commissioners a 'payment by engagement' cost model, ensuring that commissioners only fund the service for active participants. This contrasts with the block contract model of traditional face-to-face group courses, which offers commissioners limited recourse to challenge poor uptake locally.
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
By providing an accessible, flexible and effective approach to improving outcomes for people with type 2 diabetes Oviva Diabetes Support and Prevention can impact on the WM population (7.7% of whom have type 2 diabetes, and 11% of whom are likely to be at risk) beyond the local health economy by:
  • Reducing the need for people with or at risk of type 2 diabetes requiring time away from work to attend education courses or future appointments associated with the treatment of complications, thus contributing to maintaining productivity and the local economy.
  • Providing participants with personalised and remote care widens access to cohorts identified as less likely to attend traditional programmes, such as working age men, BME groups, or rural communities, particularly essential in diverse populations such as the West Midlands. Evidence of accessibility can be seen in the success of Oviva Diabetes Support in areas such as London and Devon.
  • Reducing the impact on the environment associated with delivery of traditional models of care, which drives a number of journeys for patients and staff and the environmental costs associated with physical premises.
  • Improving outcomes enables people with type 2 diabetes to remain in work; Diabetes UK has estimated that the costs of reduced productivity at work due to people with diabetes not working because of death or poor health, or working at a lower level of productivity are estimated at nearly £9 billion.
Current and planned activity: 
Oviva Diabetes Support is currently in pilot or commissioned in the following areas: North West London collaborative of CCGs, South West London collaborative, NEW Devon CCG, Chiltern and Aylesbury Vale CCGs, Swindon CCG, Somerset CCG, Leicester, Leicestershire and Rutland CCGs, and Salford CCG. Oviva Diabetes Support will soon be available to self-referral nationally as part of the Diabetes Digital Coach Test Bed. Oviva Diabetes Support is supported through NHS England through the NHS Innovation Accelerator, and has been rewarded a research grant via Innovate UK and the digital health catalyst to evaluate our clinical outcomes with King's College London.

Oviva Diabetes Prevention is part of the NHS England Healthier You - Diabetes Prevention Programme digital stream, recently launching in North West London, Somerset, and Chiltern and Aylesbury Vale CCGs.

Oviva is keen to explore opportunities for adoption of our service in the West Midlands.
What is the intellectual property status of your innovation?:
All intellectual property is owned by Oviva.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
Read more
Hide details
Innovation 'Elevator Pitch':
An artificial intelligence(AI) powered platform recommends recipes for pre-diabetics and type 2 diabetics based on personal flavour preferences, avoidances, dietary constraints, budget, weather then makes it easy to shop all the ingredients online.
Overview of Innovation:
Receiving a diagnosis of diabetes can be life changing but all too often the quality of advice recieved to help change diet is limited, especially if you have existing budgetary or dietary constraints. 
Removing friction from the process of finding and cooking a healthier diet should help people to adhere to new diets by preserving more of the will power required to maintain your resolve.
Whisk's cognitive food platform powers 100 million recipe views every month and creates 500,000 shopping lists so has a unique ability to recommend quality recipes and add them to a shopping list or cart.
A new platform will be developed with Health Exchange to empower it's cousellors to help clients to make lasting, measurable and valuable change to their diet in order to reverse, delay or manage their diagnosis successfully. 
Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Wealth creation / Digital health
Benefit to NHS:
Savings on treatment costs and complications arising from Type 2 Diabetes Management (T2DM) estimated to be as high as £3500 per user per year. If we can delay the onset of T2DM by 12 months for one user the saving is £3500. With a £35k investment we only need to help 10 people to get a return on investment within 12 months.
Initial Review Rating
4.60 (1 ratings)
Benefit to WM population:
Improved quality of life, improved health through reduced incidence of T2DM and its complications.
Current and planned activity: 
We are working with Health Exchange who deliver diabetes support services in the West Midlands community.
What is the intellectual property status of your innovation?:
The Food Genome that drives the personlised recommendations is trademarked and protected.
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
Regional Scalability:
The platform and business model is designed to be scalable globally should we see successful results.
Measures:
User numbers
Engagement rates - weekly users.
Progress against health goals - e.g. weight loss - attributable to using the platform with counsellors compared to using counsellor intervention alone.
Adoption target:
We want to demonstrate at least 100 users achieving a health goal using the platform and up to 30 000 users engaging overall.
Read more
Hide details

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