Unwin 2020: Low-Carb Diet Diabetes Remission in Primary Care

Background

Dr. David Unwin and colleagues published this service evaluation in BMJ Nutrition, Prevention & Health (PMID: 33521540), documenting outcomes from a UK general practice using low-carbohydrate dietary advice for type 2 diabetes.

Study Design

Design: Service evaluation (observational) Setting: Norwood Surgery, Southport, UK Population: 186 patients with T2D, 72 with prediabetes Intervention: Low-carbohydrate dietary advice as first-line Duration: Up to 6 years follow-up

Key Findings

Type 2 diabetes outcomes:

Outcome	Result
Drug-free remission (A1c <6.5%)	46% (77/168)
A1c reduction	−1.2% mean
Weight loss	−9.5 kg mean
Still on metformin only	26%
On insulin	Reduced from 11% to 4%

Prediabetes outcomes:

• •93% normalized HbA1c (<6%)
• •Mean A1c reduction: 0.5%

Cost savings: £50,885 annually in diabetes drug costs for this practice

Mechanistic Insights

Low-carbohydrate diet works for T2D by:

1. •Reducing postprandial glucose spikes
2. •Lowering insulin requirements
3. •Reducing hepatic fat
4. •Improving insulin sensitivity

Clinical Implications

This real-world evidence demonstrates that low-carb dietary advice:

• •Is feasible in primary care
• •Achieves high remission rates
• •Reduces medication burden
• •Provides cost savings

Metabolic Health Perspective

Dr. Unwin's practice demonstrates that metabolic optimization through diet is achievable in routine primary care with motivated patients and supportive clinicians.