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
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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's Diabetes 800 programme has shown 55% remission rate amongst patients, delivered at <50% cost (compared to a face-to-face programme) with a 100% remote & digitally enabled model. Per patient, this is an in-year cost-saving of £1472.
Overview of Innovation:
In the West Midlands, each CCG spends in the region of £10m on Diabetes Medication each year. Diabetes 800 is a programme which puts Type 2 diabetes into remission, and therefore removes the need of often unpleasant, and expensive medication for the patient. The programme achieved remission in 55% of patients, and is deliverable at <50% of the cost of a face-to-face comparable service. Diabetes 800 is a fully remote clinical service delivered 1-to-1 by diabetes specialist dietitians and diabetes specialist nurses over 12 months. The objectives are to help patients achieve remission, reduce medications, lose weight, and improve their health. It starts with a 12 week very low-calorie (800kcal/day) diet to achieve >15kg weight loss, followed by 9 months of personalised nutrition and behaviour change support. The in-year cost saving per patient is £1472.

Using one West Midlands CCG as an example, £7m is spent each year on diabetes medication. To date the CCG has spent near zero on Type 2 diabetes remission. If Diabetes 800 was available for all patients in the CCG, the cost saving is estimated to be: >£24,000,000. Type 2 diabetes remission programmes have not been routinely commissioned due to a lack of evidence and a lack of clinically proven programmes, as a result the funding opportunites are challenging. Although Oviva is working with CCGs across the UK to develop cost-saving programmes. 

The Oviva Diabetes 800 programme was developed by an expert panel of specialist clinicians, including Professor Rachael Batterham (University College London Hospital) and Dr Michelle Harvie (Manchester University Hospitals) and based on the DiRECT study and published principles from Diabetes UK.
The service has been evaluated in a clinical trial in Manchester, due for publication in March 2020. Six month outcomes show 100% of participants stopped or reduced diabetes medications, 9kg weight loss and a 55% remission rate. Oviva is leading an Innovate UK project, implementing Diabetes 800 to 300 patients. This is due to begin in January 2020 to help generate further evidence to guide commissioning.
 
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
Benefit to NHS:
NHS patients:
  • Potential for people with type 2 diabetes to achieve remission and improvements in their quality of life and psychological wellbeing from 15kg of weight loss
  • Reduced medication burden and risk of complications from their conditions
NHS commissioners:
  • NHS savings with reductions in medication & clinical services use
  • Estimated savings are approx. £1,500/patient in year 1
Primary care:
  • GPs and Practice Nurses will be inspired by new lifestyle-led ways of managing type 2 diabetes rather than a medication first approach – helping transform the NHS’s approach to care
  • Reduced demand on primary care due to better health in participants
Leadership of the UK/NHS in the emerging scientific field of type 2 diabetes remission:
Type 2 diabetes remission is a new science and by undertaking this work the UK/NHS will be a world leader in real world implementation – which can be shared both more widely in the NHS but also internationally
Initial Review Rating
5.00 (1 ratings)
Benefit to WM population:
West Midlands Population:
  • The West Midlands has over 280,000 people living with diabetes, and one of the highest prevalence rates nationally
  • There is the potential for these people with type 2 diabetes to achieve remission and improvements in their quality of life and psychological wellbeing from 15kg of weight loss
  • There is also the benefits of a reduced medication burden and risk of complications from their condition
Current and planned activity: 
Current
  • Ongoing Diabetes 800 RCT in Manchester (due for publication in March 2020)
Planned
  • Innovate UK Diabetes 800 project launch in January 2020
  • Programme launch on 1st January 2020 in a number of CCGs where early adoption has been see
Development Support
  • Where CCGs have an absence of funding allocation for Type 2 diabetes remission, support is necessary to assist in the roll out of cost-saving measures
What is the intellectual property status of your innovation?:
Oviva UK Limited owns all of the intellectual property (IP) for the Diabetes 800 programme. 
 
Return on Investment (£ Value): 
Very high
Return on Investment (Timescale): 
1 year
Ease of scalability: 
Simple
Read more
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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

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