Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years
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  • Published on:
    Remissions of type 2 diabetes in primary care. A counter response to Lean et al

    Remissions of type 2 diabetes in primary care. A counter response to Lean et al
    By Dr D Unwin and all of the authors.

    Firstly, we would like to thank Professor Lean and colleagues for their emphasis on the huge amount of common ground and agreement between us. We believe that drugs alone are very unlikely to solve the global burden of type 2 diabetes (T2D) and that the best solution lies more closely aligned with the actual cause of this disease.

    The emphasis on drug-free T2D remission in our paper is because we feel it offers a “beacon of hope” to so many people with T2D. We have seen this idea inspire many to change their lifestyle with improved health markers as a result. Much of the credit for this should go to the great work done by the DiRECT team, particularly to Professors Lean and Taylor.
    Re: “we must draw attention to a statement in this paper, now being widely quoted “Drug-free T2D remission occurred in 46% of participants”.
    In our paper we stated in the introduction that, “we hoped to answer the following question: for those patients choosing a lower carbohydrate diet to manage their T2D or prediabetes, when we compare ‘baseline data’ to ‘latest follow up’ what are the outcomes in terms of body weight, glycaemic control and effect on diabetes medication prescribing.”
    We wish to make it clear that our remission rate of 46% relates to those 128 individuals choosing the approach (27% of the practice T2D population, n=473). T...

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    Conflict of Interest:
    None declared.
  • Published on:
    Remissions of type 2 diabetes in primary care
    • Michael Lean, Physician University of Glasgow
    • Other Contributors:
      • Naveed Sattar, Physician
      • Roy Taylor, Physician
      • Emilie Combet, University Senior Lecturer
      • Chaitong Churuangsuk, Physician

    We wish to comment on the common ground and agreement that we have with the work being done by Dr David Unwin, to help people lose weight and get remissions of type 2 diabetes, and to clear up the confusion (on Twitter and elsewhere, amongst patients and professionals) which resulted from the way his audit has been presented. Most importantly, we draw attention to inappropriate comparison with intention-to-treat RCT data on remissions.
    We have previously called for high-quality clinical audits to be published in the more prominent journals (1), so it is pleasing to see the data from Unwin et al from a single practice application of advice for a low-carb diet to patients diagnosed with type 2 diabetes or prediabetes (2). They offer much that is of real value, confirming that achieving such good weight losses in a real-life setting improves all cardiometabolic risk factors, including HbA1c, BP and lipids. They also confirm that most of these metabolic benefits of weight loss, a consistent finding in RCTs, also apply to older people (over 65 years) and with longer durations of diabetes (3, 4).
    That noted, we must draw attention to a statement in this paper, now being widely quoted “Drug-free T2D remission occurred in 46% of participants”. Remarkably, 46% was the exact remission rate reported for DiRECT, a randomised controlled trial. This figure for DiRECT is 46% of all those people with T2D who were randomised to commence the programme, analysed by ‘intention...

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    Conflict of Interest:
    None declared.