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
Unwin et al. • BMJ Nutrition, Prevention & Health
Key Finding
T2D drug-free remission: 46% (59/128); HbA1c 65.5→48 mmol/mol (P<0.001); weight 99.7→91.4 kg; prediabetes: 93% normalized HbA1c; £50,885/year prescription savings
Key Findings
- 1T2D drug-free remission: 46% (59/128 patients)
- 2HbA1c improvement: 65.5 to 48 mmol/mol (P<0.001)
- 3Prediabetes: 93% normalized HbA1c (<42 mmol/mol)
- 4Prescription cost savings: £50,885/year vs area average
Original title: “Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes”
Plain English Summary
UK general practice study 2013-2019 of low-carb diet for T2D and prediabetes. 128 T2D patients: 46% achieved drug-free remission; HbA1c dropped from 65.5 to 48 mmol/mol.
In-Depth Analysis
Study Details
Lead Author: David Unwin, Norwood Surgery, Southport
Journal: BMJ Nutr Prev Health, 2020 Nov; 3(2):285-294
PMCID: PMC7841829
Key Statistics (from original paper)
Type 2 Diabetes Cohort (N=128, 23-month avg)
| Outcome | Baseline | Follow-up | P-value |
|---|---|---|---|
| HbA1c (mmol/mol) | 65.5 | 48 | <0.001 |
| Weight (kg) | 99.7 | 91.4 | <0.001 |
| Triglycerides (mmol/L) | 2.6 | 1.7 | — |
| Systolic BP (mmHg) | — | −11 | — |
| Diastolic BP (mmHg) | — | −5.1 | — |
Key Outcomes:
- •Drug-free remission: 46% (59 of 128)
- •Weight loss achieved: 94.4%
Prediabetes Cohort (N=71, 22-month avg)
- •HbA1c: 44 → 39 mmol/mol
- •93% attained normal HbA1c (<42 mmol/mol)
- •Weight: 90.6 → 82.2 kg
Subgroup Results
- •T2D >72 months duration: 24 mmol/mol HbA1c improvement
- •Severe hyperglycemia (HbA1c ≥80, n=40): 41.9 mmol/mol reduction
Cost Impact
"£50,885 per year less than average for the area" in diabetes prescribing
Source: PMC full text (PMC7841829)
Paradigm Relevance
How this study applies to different clinical perspectives:
Standard Medical
RelevantConventional clinical guidelines used by most doctors
Why it matters:
Demonstrates that low-carbohydrate dietary intervention in primary care can achieve drug-free diabetes remission in 46% of patients, with significant HbA1c and weight improvements across the cohort.
Research Consensus
RelevantCurrent scientific understanding, often ahead of guidelines
Why it matters:
Real-world evidence supporting low-carbohydrate diet as first-line intervention for type 2 diabetes and prediabetes. Those with poorest glycemic control showed greatest benefit (41.9 mmol/mol HbA1c reduction).
Metabolic Optimization
RelevantProactive targets for optimal health, not just disease absence
Why it matters:
Supports dietary intervention as primary strategy for metabolic optimization. Context for understanding physiologic adaptations like glucose sparing – demonstrates low-carb diets dramatically improve glycemic control even when fasting glucose may appear elevated.
Study Details
- Type
- Cohort Study
- Methodology
- Retrospective analysis. N = 128 T2D (23-month avg), N = 71 prediabetes (22-month avg). UK general practice 2013-2019.
Evidence Quality
Grade C - Observational/service evaluation. PMC7841829. Real-world practice data.
Related Biomarkers
Calculate & Evaluate on Metabolicum
Original Source
DOI (Digital Object Identifier) is a permanent link to this publication. Unlike website URLs that can change, a DOI always resolves to the correct source.
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