Recently published in the BMJ (British Medical Journal) were the results of an eight-year trial by a surgery in Norwood, Southport. The lead author, Dr David Unwin, had earlier been awarded an NHS Innovator of the year award in 2016 for focusing on this area of work. The research demonstrates the importance of:
- Working collaboratively with patients
- Education on health
- Behaviour change and management
- Empowering the patient
- Giving patients hope
The study is entitled: “What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss”
Advice on a lower carbohydrate diet and weight loss was offered routinely to people with type 2 Diabetes between 2013 and 2021, in a suburban practice with 9800 patients. Conventional ‘one-to-one’ GP consultations were used, supplemented by group consultations and personal phone calls as necessary. Those interested in participating were computer coded for ongoing audit to compare ‘baseline’ with ‘latest follow-up’ for relevant parameters.
For those with Diabetes onset of less than one year, remission was achieved for 77% of cases. For those who had had Diabetes for more than 15 years, this fell to 20%. Overall, 51% of patients who agreed to take reversed their diabetes. In the year ending Jan 22, the surgery spent £68,000 less than neighbouring surgeries on diabetes drugs.
Every consultation included checking and discussing body weight, with a low carb diet offered as an option alongside the key principles that good diabetic control is “about avoiding the damage caused by blood sugars spikes, that ‘time in range’ matters, a high blood sugar is often a reflection of foods eaten recently, glucose and insulin levels change in response to different foods, starchy carbohydrates comprise many glucose molecules causing significant blood sugar elevation and how weight loss was part of the process.”
The GPs and practice nurses dealt with ‘carb creep’ as soon as they noticed that weight or blood sugars had begun to climb following an initial improvement and found a quick phone call would motivate change. When less experienced practitioners were concerned that talking about obesity could be thought of as ‘fat shaming’, the more experienced clinicians encouraged them to explain that weight loss could really help health and to ask if patients were “interested to work collaboratively to achieve this”.
The practice updated its protocol to help patients maintain behaviour changes, especially around holidays, birthdays and festivities such as Christmas. They also learnt to help patients target ‘food addition’, encouraging them to avoid ‘trigger’ foods completely. Another strategy was to send out computer metrics of measurements, encouraging them to stay focused. In addition, they supported patients in reflecting on hopes and goals – and emphasise how strong the power that ‘hope of a drugs free remission’ brings to patients.
To read the full research:
Link to full research pdf here :
Norwood surgery website here