Evaluating the Effectiveness of the Reducing Weight With Intensive Dietary Support (REWIND) Programme on Type 2...

To evaluate the real-world effectiveness of the Reducing Weight With Intensive Dietary Support (REWIND) programme, offering total diet replacement or low carbohydrate diet pathways, on weight loss, glycaemic control, glucose-lowering medication prescribing and remission of Type 2 diabetes.

We conducted an observational, pre-post quasi-experimental analysis using primary care electronic health records from North West London. REWIND participants with ≥ 12 months of follow-up (n = 1051) were compared with eligible individuals who were not referred to the programme (n = 66 376). Inverse probability weighting was used to adjust for baseline group differences and outcomes estimated as average treatment effects on the treated.

At 12 months, REWIND participation was associated with greater weight loss (-2.1 kg [95% CI: -2.7 to -1.5]), reduced glucose-lowering medication prescribing (-12.2% [-13.1 to -11.3]) and increased remission (+4.2% [3.9-4.5]) compared with controls, but no significant difference in glycaemic control. The increase in remission was greater among participants following the total diet replacement pathway (+6.9% [6.1-6.8]) than the low-carbohydrate pathway (+2.9% [2.6-3.2]). Programme completers experienced greater improvements across outcomes, including an +8.1% (7.8%, 8.5%) increase in remission compared with controls.

Participation in REWIND was associated with modest improvements in weight, medication use and diabetes remission compared with usual care. Greater improvements among programme completers suggest that sustaining engagement is an important challenge in achieving benefits from similar programmes in routine care.