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Abstract
Background In a single general practice (GP) surgery in England, there was an eightfold increase in the prevalence of type 2 diabetes (T2D) in three decades with 57 cases and 472 cases recorded in 1987 and 2018, respectively. This mirrors the growing burden of T2D on the health of populations round the world along with healthcare funding and provision more broadly. Emerging evidence suggests beneficial effects of carbohydrate-restricted diets on glycaemic control in T2D, but its impact in a ‘real-world’ primary care setting has not been fully evaluated.
Methods Advice on a lower carbohydrate diet was offered routinely to patients with newly diagnosed and pre-existing T2D or prediabetes between 2013 and 2019, in the Norwood GP practice with 9800 patients. Conventional ‘one-to-one’ GP consultations were used, supplemented by group consultations, to help patients better understand the glycaemic consequences of their dietary choices with a particular focus on sugar, carbohydrates and foods with a higher Glycaemic Index. Those interested were computer coded for ongoing audit to compare ‘baseline’ with ‘latest follow-up’ for relevant parameters.
Results By 2019, 128 (27%) of the practice population with T2D and 71 people with prediabetes had opted to follow a lower carbohydrate diet for a mean duration of 23 months. For patients with T2D, the median (IQR) weight dropped from of 99.7 (86.2, 109.3) kg to 91.4 (79, 101.1) kg, p<0.001, while the median (IQR) HbA1c dropped from 65.5 (55, 82) mmol/mol to 48 (43, 55) mmol/mol, p<0.001. For patients with prediabetes, the median (IQR) HbA1c dropped from 44 (43, 45) mmol/mol to 39 (38, 41) mmol/mol, p<0.001. Drug-free T2D remission occurred in 46% of participants. In patients with prediabetes, 93% attained a normal HbA1c. Since 2015, there has been a relative reduction in practice prescribing of drugs for diabetes leading to a T2D prescribing budget £50 885 per year less than average for the area.
Conclusions This approach to lower carbohydrate dietary advice for patients with T2D and prediabetes was incorporated successfully into routine primary care over 6 years. There were statistically significant improvements in both groups for weight, HbA1c, lipid profiles and blood pressure as well as significant drug budget savings. These results suggest a need for more empirical research on the effects of lower carbohydrate diet and long-term glycaemic control while recording collateral impacts to other metabolic health outcomes.
- diabetes mellitus
- dietary patterns
- weight management
- blood pressure lowering
- lipid lowering
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Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
DU and AAK are joint first authors.
Twitter @lowcarbGP
Contributors DU initiated the approach in the practice, designed the infographics and wrote the initial drafts. JU organised and ran the group consultations, also training all clinical staff in using patients’ own goals and feedback to implement change. AAK did the initial statistics and helped with the later drafts of the paper. DC did a rewrite of the paper in its later stages. CD finished the statistics, produced the table, the box and whisker plots and linear regression models. RG wrote up the results and gave a lot of help to the entire manuscript. KM corrected several drafts and improved the style of the paper. SR found authors, chaired numerous meetings to agree on scope, influenced the style and edited across the manuscript in multiple rounds. RG and SR are joint supervising authors.
Funding Apart from an initial £7000 grant from Southport and Formby Clinical Commissioning Group (CCG), all the work has been funded by the partners at the Norwood Surgery.
Competing interests SR is co-chair of the Management Board of BMJ Nutrition, Prevention and Health, which is co-owned by the NNEdPro Global Centre for Nutrition and Health of which SR is both chair and executive director.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. The anonymised (deidentified participant data) is on an Excel spread sheet held by the lead author DU on behalf of the Norwood GP Practice.
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