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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.
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?
Diabetics get fat waists when they eat sugar and starch
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
Competing interests: No competing interests