ECO 2023: The Impact of Roczen Programmes on Glycaemic Control
The Impact of Roczen Programmes on Glycaemic Control and Requirement for Anti-Hyperglycaemic Medication
Anita Phung1, Laura Falvey1, Adrian Brown2, Dipesh Patel3, Jonathan Kwan4, Siri Steinmo5, Danielle Eaton1, Ling Chow1, Barbara McGowan6, 1Roczen Ltd, 2University College London, 3Royal Free Hospital, 4Darent Valley Hospital, 5University College London Hospital, 6Guy’s and St Thomas’ Hospital, UK
Background
Roczen delivers individualised health programmes utilising time-restricted eating and a low refined carbohydrate, moderate protein diet to those with living with overweight, obesity, prediabetes and type 2 diabetes (T2DM). The objectives of the programmes are to support weight loss, improve metabolic health and optimise well-being through establishing and maintaining lifestyle changes. Members are supported by Mentors and Clinicians on an asynchronous, digital platform, and their progress is overseen by a multidisciplinary team. There is strong evidence that significant weight loss can improve glycaemic control and reduce the requirement for anti-hyperglycaemic medication.1 The fundamental principles of the programmes include fasting, understanding the effects of food not only on glycaemic control but overall well-being, as well as health coaching to facilitate sustainable behaviour change.
Aim
The aim of this retrospective service evaluation was to assess the impact of Roczen programmes on body weight, glycaemic control and the requirement for anti-hyperglycaemic medication in the subgroup of Members with T2DM.
Method
82 members living with T2DM were enrolled over 2 years. 54.9% (n=45) were female, mean age was 53±8.6 years, mean weight was 98.6±21.2 kg, mean was BMI 35±6.7 kg/m2 and baseline HbA1c was 57±9.7 mmol/mol. The median duration of diabetes was 4 years and the range 0-22 years (n=70). 19.5% of patients were on no medications, 68.3% were taking oral medications only and 12.2% were on injectables such as insulin or GLP-1 analogues. Members were commenced on protocols utilising time-restricted-eating and low refined carbohydrate diets. They provided weight and blood pressure readings and met with their Clinician every 4 weeks. Those living with T2DM had their HbA1c repeated every 12 weeks. Clinicians reviewed these parameters and suggested optimisation of medication, where appropriate. At the time of data analysis, Members had been on their individualised programmes for an average of 49±24 weeks.
Results
80.5% (n=66) of Members living with T2DM started the programme on anti-hyperglycaemic medication. The mean weight loss was 7.3±7.2 kg and the majority (90.5%) achieved weight loss with 61.0% achieving ≥ 5% body weight loss and 35.4% achieving ≥10%. The mean reduction in HbA1c was 6.1±9.5 mmol/mol. As these Members progressed on their individualised programmes, 11% (n=9) had a dose reduction of one medication and 4.9% (n=4) had a reduction in the number of medications.
Reduction in other medications
Whilst the focus of this service evaluation was primarily to assess the impact of the programmes on glycaemic control and requirement for anti-hyperglycaemic medication in those living with T2DM, a changes in other medications were also observed, including a reduction (n=1) and stopping (n=2) antihypertensives and a reduction in analgesics (n=1). This supports existing evidence which has shown that significant weight loss can improve blood pressure control,1 reduce reflux2 and reduce pain on weight bearing joints.3
Optimising medication and health
As part of the onboarding process for Roczen programmes, baseline parameters are reviewed and if appropriate, our Clinicians liaise with primary care providers to optimise management. To help members achieve their target HbA1c levels, metformin was increased for 1 Member and initiated in 2 Members and insulin was increased for 1 Member for the same reason. 1 Member was diagnosed with hypertension and referred to the routine care provider to be initiated on antihypertensive medication.
Limitations
Whilst Roczen clinicians liaise with primary care providers to recommend medication reviews in light of an improved HbA1c result, there can often be a delay in optimising anti-hyperglycaemic medications, leading to delayed reporting of medication changes. It is important to note that this service evaluation represents a small proportion of the total number of Members enrolled on Roczen programmes as the criteria was pre- existing T2DM. The results here represent real-world, self-reported data.
Conclusions
Roczen programmes can facilitate significant weight loss, which not only can improve glycaemic control and reduce the requirement for anti-hyperglycaemic medication, but also improve other aspects of metabolic health and conditions associated with living with overweight or obesity.
Refereances:
- Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes(DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391(10120):541-551. doi:10.1016/S0140-6736(17)33102-1
- Singh M, Lee J, Gupta N, et al. Weight loss can lead to resolution of gastroesophageal reflux diseasesymptoms: a prospective intervention trial. Obesity (Silver Spring). 2013 Feb;21(2):284-90. doi: 10.1002/oby.20279
- Messier SP, Mihalko SL, Legault C, Miller GD, et al. Effects of intensive diet and exercise on knee joint loads,inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEArandomized clinical trial. JAMA. 2013 Sep 25;310(12):1263-73. doi: 10.1001/jama.2013.277669
starting with Type 2 diabetes and obesity.
