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GPs go forth

GP's online low-carb model saw '40% of diabetes patients able to cut medicines'

Two in five patients taking at least one drug to lower their blood glucose were able to cut down their medication after following a low-carbohydrate program for type 2 diabetes, a study has claimed.

The research, published in the Journal of Medical Internet Research, included 1,000 patients who used the self-management course, of which 708 reported outcomes at 12 months.

The low-carb program online platform gave participants access to modules - taught through videos, written content, or podcasts - with a new one available each week over the course of 10 weeks.

These were designed to help patients gradually reduce their total carbohydrate intake to less than 130g per day.

The program also allowed participants to submit self-monitoring data on blood glucose levels, blood pressure, mood, sleep, food intake, and body weight, as well as notifying them when a new module became available and giving them weekly automated email feedback.

Nearly 700 of the patients completed at least 40% of the online lessons, and over 500 completed all lessons in the program.

After one year, the researchers found that 26% (195) of the participants who started with blood glucose levels at or above the type 2 diabetes threshold of 6.5%, reduced it to below the threshold while taking no glucose-lowering medications or just metformin.

And 40% (289) of the participants who were taking at least one hypoglycemic medication at baseline reduced one or more of these medications.

The study also saw 464 patients lose at least 5% of their body weight.

The researchers said that while the results of the trial should be interpreted cautiously, due to the study design, they still show noteworthy changes.

They said: ‘When adults with type 2 diabetes participate in the low-carb program, and especially when they finish all 10 modules of the program, they report significantly reduced HbA1C, weight loss, and reduced medications.'

Study author and medical advisor for the low-carb program Dr David Unwin, a practising GP in Southport, said: 'The fact that over 370,000 people round the world have signed up for our online program shows how much interest there is in this approach.

'Then to be able to publish data like this gives me hope that we may have a powerful and yet affordable weapon in the fight against type 2 diabetes.'

Last month, the RCGP launched a new online course for GPs, informing them of the ‘transformative’ benefits of a lower carbohydrate diet for type two diabetes patients.

Readers' comments (9)

  • David Banner

    The patients in this study are clearly motivated, interested and proactive. They will undoubtedly do well, and deserve credit.
    But low carb diets and weight loss improving diabetic control is hardly news.
    In the real world, patients either will not or cannot maintain the low carb mantra, and soon re-gain the weight as they slip back into their old ways.
    This is great for the motivated minority, but the majority still need the drugs.

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  • The more we push lifestyle to treat diabetes the better. Drugs affect mortality little, they simply make us feel better about the numbers. It requires large investment however, to combat the huge marketing budgets of pharma.

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  • And the control group?

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  • Vinci Ho

    I have found a lot of confusing information online about ‘calories’ simply because of measurement of units and arithmetics, even in textbooks:
    (1)calorie is the fundamental unit . Kilocalorie(kcal) is 1000 calories but Kcal is also the same as Calorie(Big C calorie ); hence , Calorie=1000 calories. People often treated them the same and that is one confusion .
    (2) One gram of pure fat = 9 Calories or Kcals but pure fat is NOT the same as body fat .( 1 kg pure fat = 9000 Calories or Kcals)
    (3) One pound of body fat actually is equivalent to 3500 Calories or Kcals. As 1 kg = 2.2 pounds , hence : one kg body fat = 7700 Calories or Kcals.

    Our normal daily requirement is : 2500 Calories or Kcals for male; 2000 Calories or Kcals for female .
    So if you try to lose one kg body fat(7700 Kcals)a week ( which is the healthiest figure to lose) , you should take only 2500 minus 1100 = 1400 Calories or Kcals per day for male ; 2000 minus 1100=900 Calories or Kcals for female ,theoretically .
    It is harder for lady to lose weight physiologically .
    The happy medium thinking is to restrict daily intake between 1000 to 1500 Calories or Kcals . Still , it is not easy practically.

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  • Calorie theory has some major holes in it eg you will never weigh zero no matter how little you eat. Low carb works for many because foods that are high in carbs are often also high in fats and are addictive foods. That 1-1 ratio of fat:sugar keeps you eating and never full. I have practised low carb for 5 years myself and taught it to many patients and staff. You have nothing to lose in recommending this programme to your type 2 diabetics. If it works for them, it works. Ask yourself if you are a carb addict and if you are , try it yourself. If you have type 2 diabetes, try it, you have nothing to lose but weight and drugs. My only concern is that it does not go low enough, but then it is an online programme, and they have to be careful. Interest declaration: I am an unpaid member of the advisory board, which I do because we have a public health disaster going on here, and their results are good.

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  • Always interested in health care professionals reservations about patients ability to adhere to lifestyle interventions and not to medication when every day I meet people with diabetes (Types 1 &2) who are struggling with the burden of drug compliance. Taking medication may improve one condition but all too often causes a number of side effects that adversely affect quality of life. Eating less processed food and exercising more regularly have the potential to benefit both physical and mental health. I know which 'treatment' I have more confidence supporting patients to adhere to. Little surprise that the goal of reducing/discontinuing medication is a great motivator in it's own right.

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  • Re 'In the real world, patients either will not or cannot maintain the low carb mantra, and soon re-gain the weight as they slip back into their old ways'

    Yes fair point- I used to think that too. But as a practice since we started offering a low carb option with support to patients as an option instead of medication five years ago- 112 patients- nearly a quarter of our diabetic register have taken up the offer With average improvements in HbA1C of 22mmol/mol over an average duration of 22 months. But yes this does take time and effort but it is very rewarding work
    - Oh and we spend £38,000 less than our CCG average on drugs for diabetes each year

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  • In the real world quite a few of my patients no longer have "diabetes due to insulin resistance" as they are no longer insulin resistant. This is a massive win.

    I think we should start calling it "reversible diabetes, due to insulin resistance" to get the message across.

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  • Great for affluent, borderline type 2 diabetics but the lot I mostly see are obese, arthritic, several co-morbidities, poor, and lazy and depressed.

    Also 12 m is just the beginning in diabetes, more long term data needed.

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