Diabetes and diet, BMJ
Advice on sugar and starch is urged in type 2 diabetes counselling BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6543 (Published 06 December 2016) Cite this as: BMJ 2016;355:i6543
“I have spent 25 years failing patients with type 2 diabetes whose blood sugar levels got worse as they got steadily heavier—and nothing I could say or do made any difference,” said David Unwin, a GP partner in Southport since 1986, who was recently appointed national champion for collaborative care and support planning in obesity and diabetes at the Royal College of General Practitioners. He was speaking at a meeting at the King’s Fund in London on 30 November.
Currently, around 3.2 million people in the United Kingdom have had type 2 diabetes diagnosed, but this figure increases by 5% every year, and the direct cost to the NHS is £9.8bn (€11.6bn; $12.5bn), 10% of the total NHS budget.
Over the past five years, however, Unwin has published a series of case studies on offering to advise and support patients in eating a low carbohydrate diet.1 2
“I’m always being told this evidence is anecdotal, but it mounts up,” he told the meeting, which was organised by the Guild of Health Writers. “So often, people are unaware of the amount of glucose that results from the digestion of starchy foods like bread.”
On average, said Unwin, his patients lose 9 kg after following his advice. “And my practice now spends £50 000 less each year on insulin and type 2 diabetes drugs than is average for our area, while we also have better care in terms of haemoglobin A1c results,” he added. “Above all, these patients are so proud of taking control of their condition. I’ve never had anyone thank me for putting them on metformin, but many thank me for helping them change their diet.”
At the end of November the health secretary for England, Jeremy Hunt, told MPs that “the time has come for people with diabetes to hold the government to our promises about transforming diabetes care.” Hunt urged clinical commissioning groups to bid for funding from £40m announced by the government “designed to improve diabetes care including improving access to structured education.”
At the King’s Fund meeting Partha Kar, clinical director of diabetes at Portsmouth Hospitals NHS Trust and NHS England’s associate national clinical director for diabetes, said that the debate around the issue of diet and type 2 diabetes should be calm and level headed.
“The evidence looks promising—but a new lifestyle treatment is no more a magic bullet than a new drug. We need to keep collecting data, offer an informed choice to patients, and above all respect all views,” he said.
The Diabetes Remission Clinical Trial (DiRECT), which is due to report in 2017, is investigating whether an intensive weight management plan can bring about long term remission in type 2 diabetes. The research team, led by Roy Taylor, professor of medicine and metabolism at Newcastle University, has already published evidence that eating a low calorie diet for eight weeks puts type 2 diabetes into remission and that weight stabilises over a further six months.3
Taylor told the meeting that the DiRECT study was looking at 30 general practices in Scotland and Tyneside, all of which have recruited patients to compare the impact of long term dietary advice with the best type 2 diabetes care currently available. “We are looking forward to getting the results,” he said.
In a series of articles for the BMJ, I look at why doctors fail to learn from mistakes - they make - and how they can change that situation. Saying sorry for instance has been widely seen as something doctors cannot afford to do - yet these articles, You can say sorry in the BMJ in 2009 and Why sorry doesn’t have to be the hardest word in the BMJ in 2011, recognised that the culture of medicine in regard to litigation is changing significantly in recognition of what patients themselves want - and what is best for patient safety. I scripted an E-learning for Health online educational programme on compassion in healthcare. I also wrote for the BMJ and others about the importance of learning lessons from other high risk industries: for instance the WHO Surgical Checklist, described here in Safety First.
In 2006, I interviewed Martin Bromiley whose first wife Elaine died in the aftermath of minor surgery. It was a tragic and avoidable accident that Martin, an air pilot, quickly realised was caused by the lack of awareness of human factor in healthcare - a concept about which, he also soon realised, doctors and nurses in the NHS at the time were largely unaware. I was able to tell his story for the first time in an article in the Independent, another in the Daily Mail, a third in BMJ - also made a Radio 4 programme with Dr Phil Hammond as presenter.
The story of Elaine Bromiley's death, as told by Martin, has become a major educational tool in teaching doctors and nurses to 'wake up to human factors'. Here is Martin talking on Youtube in a video made by Laerdal Medical and uploaded in July 2011.
In 2009, I wrote about the tragic and avoidable death of six-year old Bethany Bowen during routine surgery - in the Daily Mail. This led to an interview with Bethany's mother, Clare Bowen on Patientstories, a website created by specialist healthcare advisor, Murray Anderson-Wallace.
In 2012 and 2013 with two investigative pieces on why rogue surgeons are so rarely held to account.
mistakes in birth care
In 2010, I interviewed Beatrix Futak Campbell and her husband Craig about the death of their baby Alexandra aged three days old, the victim of 'medical arrogance and a determination to hold down the rising Caesarean rate' for an article for the Daily Mail. Here's a film about Alexandra's story made by Murray and available from the Patientstories website.
Just a few months later, I covered a horribly similar story involving Emma Portagallo and her son Xavier born with severe disabilities after being delivered by forceps.
In October 2011 I wrote about a stream of cases showing that this is a rare but horribly persistent problem. Indeed this recent article on informed consent shows that the law has supported 'rogue' obstetricians who have forced their beliefs on their patients at no matter what cost.
Trusting parental instinct
How Robbie's tragic death could stop doctors telling lies to cover up their mistakes
Daily Mail, April 1 2014