Intended for healthcare professionals


Advice on sugar and starch is urged in type 2 diabetes counselling

BMJ 2016; 355 doi: (Published 06 December 2016) Cite this as: BMJ 2016;355:i6543
  1. Jane Feinmann
  1. London

GPs have been urged to help patients with type 2 diabetes make informed choices about their treatment, including advice that reducing their daily intake of sugar and starchy carbohydrate could reverse the disorder.

“I have spent 25 years failing patients with type 2 diabetes whose blood sugar levels got worse as they got steadily heavier—and nothing I could say or do made any difference,” said David Unwin, a GP partner in Southport since 1986, who was recently appointed national champion for collaborative care and support planning in obesity and diabetes at the Royal College of General Practitioners. He was speaking at a meeting at the King’s Fund in London on 30 November.

Currently, around 3.2 million people in the United Kingdom have had type 2 diabetes diagnosed, but this figure increases by 5% every year, and the direct cost to the NHS is £9.8bn (€11.6bn; $12.5bn), 10% of the total NHS budget.

Over the past five years, however, Unwin has published a series of case studies on offering to advise and support patients in eating a low carbohydrate diet.1 2

“I’m always being told this evidence is anecdotal, but it mounts up,” he told the meeting, which was organised by the Guild of Health Writers. “So often, people are unaware of the amount of glucose that results from the digestion of starchy foods like bread.”

On average, said Unwin, his patients lose 9 kg after following his advice. “And my practice now spends £50 000 less each year on insulin and type 2 diabetes drugs than is average for our area, while we also have better care in terms of haemoglobin A1c results,” he added. “Above all, these patients are so proud of taking control of their condition. I’ve never had anyone thank me for putting them on metformin, but many thank me for helping them change their diet.”

At the end of November the health secretary for England, Jeremy Hunt, told MPs that “the time has come for people with diabetes to hold the government to our promises about transforming diabetes care.” Hunt urged clinical commissioning groups to bid for funding from £40m announced by the government “designed to improve diabetes care including improving access to structured education.”

At the King’s Fund meeting Partha Kar, clinical director of diabetes at Portsmouth Hospitals NHS Trust and NHS England’s associate national clinical director for diabetes, said that the debate around the issue of diet and type 2 diabetes should be calm and level headed.

“The evidence looks promising—but a new lifestyle treatment is no more a magic bullet than a new drug. We need to keep collecting data, offer an informed choice to patients, and above all respect all views,” he said.

The Diabetes Remission Clinical Trial (DiRECT), which is due to report in 2017, is investigating whether an intensive weight management plan can bring about long term remission in type 2 diabetes. The research team, led by Roy Taylor, professor of medicine and metabolism at Newcastle University, has already published evidence that eating a low calorie diet for eight weeks puts type 2 diabetes into remission and that weight stabilises over a further six months.3

Taylor told the meeting that the DiRECT study was looking at 30 general practices in Scotland and Tyneside, all of which have recruited patients to compare the impact of long term dietary advice with the best type 2 diabetes care currently available. “We are looking forward to getting the results,” he said.


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