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Rapid Responses: Rapid Responses published:
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GTT is available in primary care
- Rupert Gude (27 May 2008)
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Diabetics get fat waists when they eat sugar and starch
- Laurence E Wood (30 May 2008)
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Rupert Gude, Retired GP Tavistock, Devon, PL19 9EL
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Dr Goyder relates that one of the barriers to screening for diabetes is the limited access to oral glucose tolerance test (GTT) in primary care. We have been doing GTTs in my old practice for over 20 years and our biggest problems was getting cooperation from the biochemistry lab as to the appropriate form of glucose load. However it did take a significent committment in at first nursing then phebotomist time and hence cost to the practice. Dr Goyder sees the solution to limited access as a practical one of education and improved logistics. I think that of more fundamental importance is the reluctance of many General Practitioners to be involved in preventive work and their extreme reluctance to commit their own finances to pay for this work. Will health care consortiumms in policlinics be any different? Competing interests: None declared |
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Laurence E Wood, Lead Obstetrician UHCW, COventry, CV2 2DX
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It was refreshing to read the analysis of Gillies et al1 that screening for type II diabetes is cost effective. Both the article and the related editorial2 however, contained two vital omissions. Firstly, if screening is cost effective in the general population, then how much more would it be in a high risk group? Waist - height ratio is as easy, free and practical to measure as Body Mass Index (BMI), and not only targets those at risk of diabetes, but also those at risk of its main complications3. Use of genetic and family history could enhance this. Secondly, contrary to the editorial comments, there is indeed an effective and affordable lifestyle intervention to reduce the burden of type 2 diabetes: low glycaemic index (GI) diet4. The obesity and diabetes epidemic has been associated with a massive shift to carbohydrate consumption, and especially to consumption of high GI processed carbohydrates such as crisps and fries. As an antidote, not only does low GI diet exclude most junk foods, but it is also simple, palatable, affordable and effective, with no down sides. It is a less dramatic version of the popular ‘Atkin’s Diet’. Despite this, many dietary departments, slavishly following the poorly-evidenced Food Standards Agency’s (FSA) ‘Balance of Good Health5’, positively encourage carbohydrate intake with every meal. Indeed, the FSA cite high GI food such as bread and potatoes as ones we should have “lots” of – oblivious to their own observation that no more than one third of the diet should be carbohydrate. It comes down to common sense: diabetes is intolerance to sugar, and to foods easily turned to sugar. Consuming such foods gives susceptible people an even fatter waist, and promotes the development of diabetes. Let us find such people and tell them this. 1. Gillies CL IT AL different strategies for screening and prevention of diabetes in adults, cost effectiveness analysis BMJ 2008;336:1180-4. 2. Goyder EC screening for and prevention of type II diabetes BMJ 2008;336:1140-1. 3. .Ashwell M Hsieh SD Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity International Journal of Food Sciences and Nutrition 2005; 56(5): 303 - 307 4. Ludwig DS The Glycemic Index Physiological Mechanisms Relating to Obesity, Diabetes, and Cardiovascular Disease JAMA. 2002;287:2414-2423. 5. Balance of Good Health, Food Standards Agency London, 2001, http://www.food.gov.uk/multimedia/pdfs/bghbooklet.pdf Competing interests: None declared |
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