The first year of a diabetes diagnosis offers an ‘important window of opportunity’ for disease remission with a low carbohydrate diet, a GP study has shown.
Analysis of data from a practice that routinely offered carbohydrate diet and weight loss advice for type 2 diabetes found 39% of patients were willing to try the approach.
In those who had diabetes for less than a year, 77% achieved remission, the practice reported from records between 2013 and 2021.
For patients who had the condition for more than 15 years, remission was 20%, the team from the Norwood Surgery in Southport reported in BMJ Nutrition, Prevention and Health.
Over an average of 33 months, there was a mean weight loss of 10kg and median HbA1c fell from 63mmol/mol to 46, the audit showed.
Overall half the 186 patients who chose the diet option achieved remission which led to prescribing savings of £68,353 a year on diabetes drugs by 2022 compared with neighbouring practices.
The level of support provided by the practice depended on the patient they said but averaged at three consultations a year as well as optional group sessions held every six weeks.
Patients were also given educational resources including a diet sheet and computer-generated graphs of metrics such as weight and HbA1c were provided so patients could see their progress.
Dr David Unwin, GP and lead researcher who has also written the RCGP e-learning module on type 2 diabetes and the glycaemic index, said helping such a large proportion of patients achieve remission had really brought back the joy of general practice.
He added: ‘In a previous publication we showed that people with pre-diabetes stand a 93% chance of achieving normal blood sugars if they try a low carb diet so they are another group worth targeting.’
Dr Unwin said those newly diagnosed would need three or four appointments a year – maybe less for those with pre-diabetes – and group meetings had made offering support more affordable for the practice.
The team concluded: ‘The remission rate drops after that first year, suggesting that those leaving it longer are missing an important window of opportunity’ and added that practices should focus on metabolic age (duration of diabetes) rather than chronological age of patients who might particularly benefit.
Savings on diabetes drugs identified by the practice also do not take into account that antihypertensive drugs can often be deprescribed too said Dr Unwin.
‘The benefit of deprescribing drugs for diabetes or avoidance of repeat prescribing is that any savings are recurring,’ he said.
‘We save £68,000 per year but for our practice the approach is first line now. For less experienced practices the savings would be less but as we found, the savings grow year on year.’
