Unwin 2020: Low Carb Diet in Type 2 Diabetes - General Practice Evidence

Background

This study from Dr. David Unwin's UK general practice (PMID: 33521540) provides real-world evidence for low-carbohydrate dietary intervention in type 2 diabetes management in primary care.

Study Design

Design: Practice-based service evaluation Population: Patients with type 2 diabetes and prediabetes Approach: Low-carbohydrate dietary advice as primary intervention Monitoring: Regular HbA1c, weight, medication review

Key Findings

Comprehensive outcomes:

Metric	Before	After	Change
Mean HbA1c	7.8%	6.6%	−1.2%
Mean weight	90 kg	80.5 kg	−9.5 kg
Diabetes drugs	Higher	Lower	Reduced
Insulin use	11%	4%	−7%

Key achievements:

• •46% achieved diabetes remission (A1c <6.5% without meds)
• •93% of prediabetics normalized glucose
• •Sustained over 6-year follow-up in many patients
• •Annual savings of £50,885 in drug costs

Mechanistic Insights

Success relates to addressing the root cause:

• •Carbohydrate drives glucose and insulin
• •Reducing carbs lowers both
• •Hepatic fat decreases
• •Insulin sensitivity improves

Clinical Implications

Low-carbohydrate dietary advice can be implemented in routine primary care with significant clinical and economic benefits. Requires motivated patients and knowledgeable clinicians.

Metabolic Health Perspective

This exemplifies metabolic optimization in practice: achieving disease reversal through lifestyle rather than medication escalation. The Norwood Surgery model is being replicated across the UK.