10 years of UK NHS ‘real world’ experience
Dr David Unwin FRCGP, RCGP clinical expert in diabetes
COI. Level 2 (United Healthcare)
HbA1c in mmol/mol 2019 -2023
HbA1c 95mmol/mol
Or 10.8%
? HbA1c 36mmol/mol
Or 5.4%
X9 ? We have 133 cases of
remission like this
Drug-free type 2 diabetes remission lasting 2+ years
*Heald AH, Stedman M, Davies M, Livingston M, Alshames R, Lunt M, et al. Estimating life years lost to diabetes: outcomes from analysis of
National Diabetes Audit and Office of National Statistics data. Cardiovascular Endocrinology & Metabolism. 2020;9(4):183-5.
Type 2 Diabetes remission rates Norwood Surgery
March 2017- May 2023; low carb approach
Mean Number of Remission rate
Number Number of T2D Remission rate
Data collected duration of T2D cases in for people who
choosing the patients on the for Norwood
To: low carb remission choose the low
approach diabetic register practice
approach HbA1c <48* carb approach
March 2017 13 months 15 48 31% 416 4%
May 2018 20 months 41 106 39% 454 9%
January 2019 22 months 59 123 48% 469 13%
March 2020 30 months 68 143 48% 485 14%
May 2022 28 months 117 224 52% 536 22%
May 2023 30 months 130 258 (45%) 50% 569 23%
*Type 2 diabetes remission defined as: previous diagnosis of type 2 diabetes (T2D) by WHO criteria and HbA1c
<6.5% (<48mmol/mol) without antidiabetes medication.
Those achieving T2D remission are on 77grams of carb a day (SD35gr)
Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: Unwin, D., et al.,
BMJ Nutrition, Prevention & Health, 2020
What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet. Unwin D. Taylor R. et al.
BMJ Nutrition, Prevention & Health, 2023
A high blood sugar?
1. See this as a ‘puzzle to be solved’
rather than a ‘problem’
2.So often it’s something you ate
3.Try asking ‘where is the sugar
in my diet coming from?’
GLUCOSE OUT OF RANGE!
Chicken butter
curry
with roasted
sprouts
T2 Diabetes? Just eat nutrient dense foods
that don’t put your blood sugar up?
Spend on antidiabetic drugs (BNF 6.1) vs patients on list by
NORWOOD SURGERY and other practices in Southport area. January 2022
Norwood Surgery spends £68,353 less per year
on drugs for diabetes than is average for the area
If all the practices in the UK prescribed like this
We could save £270mill per year
Practices in Southport and Formby Area
Cohort of 186 T2D low carb participants.
Mean (SD) duration of diet: 33 (27) months: cardiovascular risk
Unwin D., Taylor R. et al., What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a
lower carbohydrate diet with weight loss. BMJ Nutrition, Prevention & Health, Jan 2023: p. e000544.
Baseline Matched
Latest follow up Difference
measure % change p value pairs
median (IQR) Mean (SD)
median (IQR) n (%)
Age (years) 63 (54, 73) - - - - -
Weight (kg) 97 (84,109) 86 (76, 99) -10 (8.9) 10.3 <0.001 181 (97%)
HbA1c (mmol/mol) 63 (54, 80) 46 (42, 53) -21 (19) 33.3 <0.001 183 (98%)*
Serum cholesterol (mmol/L) 4.9 (4.1, 5.7) 4.3 (3.6, 5.0) -0.5 (0.9) 10 <0.001 107 (58%)
HDL cholesterol (mmol/L) 1.1 (1.0, 1.3) 1.2 (1.0, 1.5) +0.1 (0.3) 9 0.002 114 (61%)
Total chol/HDL ratio 4.0 (3.0, 5.0) 3.9 (3.0, 4.4) 0.5 (0.9) 12.5 <0.001 102 (58)
Calculated LDL cholesterol (mmol/L) 3.6 (2.9, 4.5) 3.1 (2.5, 3.6) -0.5 (0.9) 13.9 <0.001 100 (54%)
Triglyceride (mmol/L) 2.1 (1.4, 3.2) 1.4 (1.0, 1.9) -0.9 (1.2) 42 <0.001 108 (58%)
Systolic BP (mmHg) 140 (134, 150) 132 (122, 138) -12 (16) 8.6 <0.001 128 (69%)
Diastolic BP (mmHg) 80 (78, 90) 78 (70, 80) -5.8 (9.7) 7.2 <0.001 128 (69%)
Dave aged 60 diagnosed with
type 2 diabetes.
HbA1c was 108mmol/mol (12%)
Weight was 118.8kgs,
Waist was 50 inches.
Just 16 weeks later.
HbA1C now 40mmol/mol (5.8)
Weight is 100.4kgs,
Waist is 45 inches.
