Feature Type 2 Diabetes

Low calorie and low carb diets for weight loss in primary care

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1122 (Published 13 March 2018) Cite this as: BMJ 2018;360:k1122
  1. Jane Feinmann, freelance journalist, London, UK
  1. jane{at}janefeinmann.com

Evidence is beginning to emerge on how best to lose weight to put type 2 diabetes into remission, but some GPs are already helping their patients eat specific diets. Jane Feinmann reports

A change in the advice that general practitioners give to the four million UK patients with type 2 diabetes might help as many as half of them put their disease into remission, the results of a recent study suggest.

The Diabetes Remission Clinical Trial (DiRECT), a cluster randomised controlled trial published in the Lancet last December,1 indicates that weight management led by primary care professionals might normalise blood sugar levels without the use of drugs (box 1). The authors say that this provides evidence for a change in the management of diabetes in primary care.

Box 1

Trialling low calorie diet advice

DiRECT, the biggest ever study funded by the charity Diabetes UK, tracked 298 patients who had had diabetes diagnosed in the past six years.1 Half were randomly assigned to take diabetes drugs and receive conventional weight loss advice (see box 3). The other half were told to stop taking all drugs for diabetes and to eat a low calorie diet that was balanced in nutrients—shakes or soups containing no more than 853 calories a day—for up to five months. They were then given intensive guidance to gradually reintroduce a normal diet tailored to the individual over two to eight weeks. This was delivered through general practices in Scotland and Tyneside, supported by an evidence based lifestyle weight management programme designed for the NHS.

“This is a programme that doesn’t just appeal to people who want weight loss for mainly social reasons,” said Michael Lean, coresearch lead of DiRECT and Glasgow University chair of nutrition. “In DiRECT 40% of the patients were from the two most deprived socioeconomic groups, and 40% were …

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