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Published by NCH Software. Repeat as necessary with third, fourth or more drugs increasing each to maximum dose. This is a safety measure because blood glucose levels fall rapidly on the diet. After 2 weeks of TDR if osmotic symptoms thirst, polyuria are troublesome or if random capillary glucose is over 20 mmol, check HBA1c and that weight loss is as anticipated. If it is not, discuss whether any other help would be helpful with following the low calorie liquid diet. If weight loss is satisfactory but control is still inadequate, consider introducing an oral hypoglycaemic agent.
Reintroduce metformin mg bd. If this has previously caused GI upset for the individual, use the slow release preparation. If, after 4 weeks, control is still inadequate, add gliclazide 80 mg od or other sulphonylurea if previously used, or if preferred.
Additional file 1: Table 1. DOCX Competing interests. ML and NB have received funding from Cambridge Weight Plan for conference attendance and for other departmental research. WL drafted the manuscript. All authors critically reviewed the manuscript, and have read and approved the final version.
Wilma S. Leslie, Email: ku. Ian Ford, Email: ku. Naveed Sattar, Email: ku. Kieren G. Hollingsworth, Email: ku. Ashley Adamson, Email: ku. Falko F. Sniehotta, Email: ku. Louise McCombie, Email: gro. Naomi Brosnahan, Email: ku. Hazel Ross, Email: gro. John C. Mathers, Email: ku. Carl Peters, Email: ku.
George Thom, Email: ku. Alison Barnes, Email: ku. Sharon Kean, Email: ku. Yvonne McIlvenna, Email: ku. Angela Rodrigues, Email: ku. Lucia Rehackova, Email: ku.
Sviatlana Zhyzhneuskaya, Email: ku. Roy Taylor, Email: ku. Mike E. Lean, Email: ku. National Center for Biotechnology Information , U. BMC Fam Pract. Published online Feb Hollingsworth , Ashley Adamson , Falko F. Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Received Dec 27; Accepted Jan This article has been cited by other articles in PMC. Abstract Background Despite improving evidence-based practice following clinical guidelines to optimise drug therapy, Type 2 diabetes T2DM still exerts a devastating toll from vascular complications and premature death. Discussion This study will establish whether a structured weight management programme, delivered in Primary Care by practice nurses or dietitians, is a viable treatment to achieve T2DM remission.
Electronic supplementary material The online version of this article doi Keywords: Type 2 diabetes, Weight management, Total diet replacement, Primary care. Background T2DM is closely linked to obesity, particularly adult weight gain, and is the main contributor to rising healthcare costs of obesity [ 1 , 2 ]. Participant recruitment Two hundred and eighty participants per arm will be recruited to the study from general practice Fig.
Open in a separate window. Trial procedures Practices randomised to control will continue to deliver usual diabetes and obesity management as per current clinical guidelines. Weight loss maintenance phase weeks 19— Participants will be advised to follow a food based diet and will be provided with an individually tailored energy prescription, to support weight stabilisation and prevent weight regain. Patient safety Intervention participants will be closely monitored throughout the study Additional file 1 : Table 1.
Protocol delivery fidelity A standard training protocol has been developed to minimise variability and maintain intervention protocol fidelity across all practices. Mechanistic studies Tyneside Tyneside participants intervention 68 ; control 20 will participate in mechanistic studies to define the physiological mechanisms underlying the long term remission of T2DM Additional file 1 : Table 1.
Programme acceptability, process evaluation and Quality of Life Participants At least 10 intervention and 10 control participants in both Scotland and Tyneside will be invited to participate in semi-structured face-to-face or telephone interviews focusing on experiences, barriers, facilitators and behaviour strategies for self-regulation. Ecological Momentary Assessment EMA All interviewed participants 20 in intervention group and 20 in control group will be invited to complete an Ecological Momentary Assessment EMA for 12 weeks from the baseline interview and for 8 weeks weeks 3—10 inclusive during the weight maintenance phase.
Non-responders Anonymised data age, sex, BMI and duration of diabetes for all patients identified as satisfying the recruitment criteria and invited to participate will be recorded. Protocol When antihyperensive drugs are stopped, re-emphasise the importance of avoiding sodium salt In the first 2 weeks after stopping antihypertensives and diuretics: If systolic BP over mmHg on repeated measurement - restart one drug, as below.
Increase dose weekly to achieve target. Order of reintroduction of previously used drugs ACE inhibitors ramipril. Angiotensin receptor blockers irbesartan, candesartan etc. Thiazide type bendroflumethazide, indapamide etc. Spironolactone Calcium channel blocker nifedipine, amlodipine etc.
Beta blocker atenolol, labetolol etc. Alpha blocker doxazosin, prazosin All others. Protocol After 2 weeks of TDR if osmotic symptoms thirst, polyuria are troublesome or if random capillary glucose is over 20 mmol, check HBA1c and that weight loss is as anticipated. Start at the lowest dose and increase gradually.
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