Authors' replyBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6985.1006 (Published 15 April 1995) Cite this as: BMJ 1995;310:1006
- R R Holman,
- Robert Turner,
- Carole A Cull,
- Charles Fox
- Consultant physician Clinical reader Statistician Consultant physician United Kingdom Prospective Diabetes Study, Diabetes Research Laboratories, Radcliffe Infirmary, Oxford OX2 6HE
EDITOR,—The dietary advice given to subjects in the United Kingdom prospective diabetes study is probably considerably more than that given as part of usual care. We have described in detail the response to diet over the initial three to four month run in period, when patients were seen monthly by a dietitian.1 The reduction in fasting plasma glucose concentration was shown to depend on the degree of weight loss and the initial glucose concentration. In each clinic in the study a dietitian gave individual dietary advice to all subjects, irrespective of the treatment to which they had been allocated, and reviewed admitted compliance and gave further advice as necessary throughout the study. Over three years the group taking diet alone did not completely regain the mean 3.7 kg lost during the initial three to four month dietary period. Although we do not have formal dietary measures in all subjects in the study, the admitted dietary intake in a randomised subset, derived from three day food diary assessments, showed no significant differences between the treatment groups with respect to dietary composition.2 We think it unlikely that dietary differences between the randomly allocated groups accounted for the differences in blood glucose control we described.
Long term dietary compliance is a well recognised problem in diabetic subjects, and many patients become refractory to dietary advice.3 We appreciate the concern that even more intensive dietary advice might have been more effective, but the degree of weight loss required to attain near normal glucose concentrations during the three month run in period was usually more than could be achieved realistically.1 The conclusion that the pharmaceutical agents studied were each more effective than attentive dietary advice alone is justified.