Diabetes: Hope for the future, frustration with the status quo

Hope and frustration. That is what I feel on this day dedicated to a disease with devastating consequences. Diabetes (type 1 and 2) is the leading cause of blindness and kidney failure, and globally leads to an amputation every minute. 

The International Diabetes Federation highlights "well-being" for those with diabetes this year and they note that "This World Diabetes Day, 14 November, let’s put well-being at the heart of diabetes care and start the change for a better diabetes life."

Diabetes is associated with obesity, mental ill health, heart disease, many cancers, neurodegenerative diseases and particularly for those with type 1 diabetes, a life of injecting insulin daily.

But there is an increasing body of evidence that we can really make a difference to the more than 1 in 10 of the world population that has been diagnosed with diabetes, and also the 30-35 odd percent in many countries with pre (type 2) diabetes. 
The best way to do this is to focus on the physiology. 

Type 2 Diabetes is in basic terms a consequence of insulin resistance, which is caused by chronically high levels of insulin (hyperinsulinemia) due to blood glucose levels being raised too high, too frequently. The conclusion is obvious: Well let's not raise blood glucose too, high too frequently.  

By focussing on blood sugar, and the foods that raise blood sugar, we can significantly improve the health of those with both type 1 and type 2 diabetes.  

And that is what hundreds of clinicians including GPs and endocrinologists are now doing: addressing the root cause – insulin resistance stemming from too many carbs. They are improving the health of all their diabetic patients - putting type 2 diabetes into remission for almost 50% of cases, and significantly increasing the time 'in range' , improving stability for type 1 diabetics and reducing their insulin dosage by up to 80%. As a result, this also reduces the risk of hypoglycemic episodes, a key concern for those with type 1 diabetes. And as a byproduct they are improving blood pressure, weight, and triglyceride levels, while reducing or eliminating medication. 

Dr David Unwin has been offering low carbohydrate interventions to his diabetic patients at his GP practice in Southport for over ten years. Based on a study he published last year, he has about 470 patients with type 2 diabetes in his practice. 186 (39%) of these chose to participate in a low carbohydrate approach. 

Almost 3 years on, this group has maintained a significant weight loss of over 10% and average glucose levels in the non-diabetic range. Additionally, other cardiovascular risk factors like blood pressure and key cholesterol levels have improved. 

94 (51%) of the 186 are now in diabetes remission (defined as previous diagnosis of type 2 diabetes with an HbA1c <6.5% without antidiabetic medication).  

Having spoken to one of Dr Unwin's patients myself, I know how quality of life improves for those that manage to improve their metabolic health and diabetes. The improved mobility, energy and mental wellbeing allows for more time spent engaging in activities with family, friends, children and grandchildren. They take far fewer medications, or lower doses, and have such a changed positive outlook of their future health prospects and indeed look forward to growing old. 

Thanks to pioneers like David Unwin and many of his colleagues, the Diabetes UK website now discusses diabetes remission extensively. 

My frustration lies in the fact that despite the physiology being so clear, and the outcomes when respecting being so beneficial, this is not yet standard of care.

The American Diabetes Association has almost no mention of remission, and the International Diabetes Federation mentions it only once (a news item related to a Lancet article). This should be headline stuff.

Let's do better to give hope and a healthier life to those with diabetes. We really can improve the well-being of what is now about 10% of the population, and the third in many countries with prediabetes on their way to having type 2 diabetes. 

The topic of Diabetes and obesity, in relation to diet was extensively covered in the Food for Thought conference held in 2023.