How one GP saved thousands on diabetes care
The best approach to reversing Type 2 diabetes is a hotly contested subject. While experts agree that sustained weight loss is a fundamental part of the process, the diet a person should adopt to achieve that weight loss, and improve their glycaemic control, is less commonly agreed upon. Some studies have shown promising results for the very-low-calorie-diet approach, while others suggest the Mediterranean diet holds the key to success. What Dr David Unwin discovered in 2013 was that for certain patients, a low carb diet may trump all others.
Conventional wisdom at the time was to medicate rather than prevent, with prescribing budgets eaten up by diabetes drugs as diagnoses soared across the UK. Dr Unwin had spent a quarter of a century recommending traditional drug treatment for diabetes, in line with NHS treatment guidelines.
Then he stumbled upon the low-carb approach. Championed by prominent advocates diabetes.co.uk and others, the diet showed serious promise in improving glycaemic control for people with diabetes. He began recommending it to his patients as an alternative to medication and, so as to fully understand the difficulties his patients may face in sticking to low-carb, also adopted the diet himself.
“Back in 2013, our GP practice had a very ‘drug centred’ approach to Type 2 diabetes,” he says. “Lifestyle medicine was almost unheard of. The partners felt that rather than going on about dietary carbs I should concentrate on seeing properly sick people. This meant the only way forward was to work for free in my own time on a Monday evening. My wife came in to help me staff the surgery.
“After six months, the partners could see my results were beating what they could do with drugs, particularly when the first few patients managed to come off medication. Initially I was unsure about the low carb approach so I joined my patients on the diet and we learnt together, trialling recipes we found on the internet. We even arranged practice based cooking demos.
In 2015/16, Dr Unwin’s practice saved £40,000 on drugs. To put that in perspective, if every one of the UK’s 7,435 practices were to make an equal saving, the NHS would be £297 million better off each year. So the practice partners were, by then, firmly on side – but challenging official treatment advice across the whole of the health service was another matter entirely.
Dr Unwin was very vocal about his patients’ successes with low-carb online and in the press, publishing extensive research into the approach as an alternative to drug therapy. He also developed a peer-reviewed e-learning module for GPs explaining the science behind the low carb approach, its impact on glycaemic control and how to discuss it with patients, which won him the prestigious accolade of NHS Innovator of the Year. Last week, it was chosen by the Royal College of General Practitioners as its Course of the Month for November.
“My generation of doctors was brought up with a deep distrust of ‘the media’,” he says. “My partners were worried the first time I appeared in The Daily Mail. Despite the risks I feel the internet is democratising medicine – making relevant information so available.
“I have come to feel we can’t just ignore the internet; it’s not going to go away, so we should join in. It’s a great way to ‘find your tribe’ and become more effective. The low carb movement has a huge presence on social media. There are risks though, particularly around the temptation to give advice. So often I have to explain we supply general information online. Personal advice is something you get from your own doctor!”
For the next three years, David plans to continue encouraging doctors to promote lifestyle change over medication. “I think the idea of reversing type 2 diabetes or more properly putting it into remission without drugs is probably a valid goal for about 50% of people with diabetes.
“The longest remission in my practice is 9 years. I feel this is such a hopeful message, that there is so much people can do themselves to make a difference by cutting back on the dietary sources of glucose.
“I know that for my first 25 years of medicine I failed to make this clear enough and was too quick to prescribe lifelong medication. My goal is to help other doctors tap into the wonderful potential of people to help themselves.”
Dr David Unwin will share insights from his experience at Diabetes Professional Care 2018, 15:15-15:45 Wednesday 14 November. Register for your free place at https://www.diabetesprofessionalcare.com