A thread about T2 diabetes for #WorldDiabetesDay

I've been an NHS doctor for 19 years.

During that time we've seen some amazing developments in diabetes care including some exciting technology such as continuous glucose monitoring, insulin pumps and transplant surgery.

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We've seen the arrival of many new drugs to add to our tool box for managing patients with this chronic condition.

Also very low calorie diets and bariatric surgery.

And diabetes prevention programmes to help delay the progression from pre-diabetes to established T2.

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A long time ago, as an SHO in diabetes/endocrinology, I remember thinking how strange it was that we prescribed increasing doses of insulin to patients who struggled with their weight.

Not surprisingly this seemed to make them hungrier leading to more weight gain.

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Many were clearly insulin resistant so we increased their dose!

I had a strong sense that T2 was reversible so since then have tried to help pts achieve remission through advising:

Switch white carbs to brown
Avoid sat fat
Count calories/watch portions
Exercise

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Sadly this didn't get the remissions I'd hoped for.

A lot of expensive meds were started & ramped up.

Some tolerated, some not

There were warnings about possible risks of pancreatitis, heart failure, bladder cancer, genital/urinary infections..

Not much to celebrate

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Then in 2018 things started to change.

We discovered that @lowcarbGP was having unprecedented success in achieving T2 remission in his patients.

This was simply by encouraging them to reduce sugar AND starchy carbs.

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86 of his pts with previously established T2D are now in sustained DRUG-FREE REMISSION

Of his patients with pre-diabetes 93% now have HbA1c in the normal range.

Is there any other approach or drug that achieves these results?

Our Diabetes Prevention Programmes don't.

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Since we've adopted this approach we're seeing similar results

FINALLY SOME REMISSIONS

Lots of reversal of prediabetes (not just a delay in progression to T2)

Plenty of:

Deprescribing
Healthy patients, back in control
Job satisfaction for GPs & PNs

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Patients like this approach because they're not hungry all the time and thinking about food.

They're eating real unprocessed food that doesn't cause rollercoaster blood sugars.

Even brown carbs cause blood sugars to spike

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So I would encourage any GP/practice nurse/dietitian who isn't getting great results with their patients with T2D..

Take a look

10/10 https://nutrition.bmj.com/content/early/2020/11/02/bmjnph-2020-000072