Unwin David, Delon Christine, Unwin Jen, Tobin Simon, Taylor Roy
NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.
Norwood surgery, Southport, UK.
BMJ Nutr Prev Health. 2023 Jan 2;6(1):46-55. doi: 10.1136/bmjnph-2022-000544. eCollection 2023.
Type 2 diabetes (T2D) is often regarded as a progressive, lifelong disease requiring an increasing number of drugs. Sustained remission of T2D is now well established, but is not yet routinely practised. Norwood surgery has used a low-carbohydrate programme aiming to achieve remission since 2013.
Advice on a lower carbohydrate diet and weight loss was offered routinely to people with T2D between 2013 and 2021, in a suburban practice with 9800 patients. Conventional 'one-to-one' GP consultations were used, supplemented by group consultations and personal phone calls as necessary. Those interested in participating were computer coded for ongoing audit to compare 'baseline' with 'latest follow-up' for relevant parameters.
The cohort who chose the low-carbohydrate approach (n=186) equalled 39% of the practice T2D register. After an average of 33 months median (IQR) weight fell from 97 (84-109) to 86 (76-99) kg, giving a mean (SD) weight loss of -10 (8.9)kg. Median (IQR) HbA1c fell from 63 (54-80) to 46 (42-53) mmol/mol. Remission of diabetes was achieved in 77% with T2D duration less than 1 year, falling to 20% for duration greater than 15 years. Overall, remission was achieved in 51% of the cohort. Mean LDL cholesterol decreased by 0.5 mmol/L, mean triglyceride by 0.9 mmol/L and mean systolic blood pressure by 12 mm Hg. There were major prescribing savings; average Norwood surgery spend was £4.94 per patient per year on drugs for diabetes compared with £11.30 for local practices. In the year ending January 2022, Norwood surgery spent £68 353 per year less than the area average.
A practical primary care-based method to achieve remission of T2D is described. A low-carbohydrate diet-based approach was able to achieve major weight loss with substantial health and financial benefit. It resulted in 20% of the entire practice T2D population achieving remission. It appears that T2D duration <1 year represents an important window of opportunity for achieving drug-free remission of diabetes. The approach can also give hope to those with poorly controlled T2D who may not achieve remission, this group had the greatest improvements in diabetic control as represented by HbA1c.
2型糖尿病（T2D）通常被视为一种渐进性的终身疾病，需要越来越多的药物治疗。T2D的持续缓解现已得到充分证实，但尚未常规应用。自2013年以来，诺伍德手术采用了低碳水化合物方案以实现缓解。
2013年至2021年期间，在一个拥有9800名患者的郊区诊所，常规为T2D患者提供低碳水化合物饮食和减肥建议。采用传统的“一对一”全科医生咨询，并根据需要辅以小组咨询和个人电话沟通。对有兴趣参与的患者进行计算机编码，以便进行持续审计，比较相关参数的“基线”和“最新随访”情况。
选择低碳水化合物方法的队列（n = 186）占诊所T2D登记患者的39%。平均33个月后，体重中位数（四分位间距）从97（84 - 109）kg降至86（76 - 99）kg，平均（标准差）体重减轻-10（8.9）kg。糖化血红蛋白（HbA1c）中位数（四分位间距）从63（54 - 80）降至46（42 - 53）mmol/mol。糖尿病病程小于1年的患者中，77%实现了缓解，病程大于15年的患者缓解率降至20%。总体而言，该队列中51%的患者实现了缓解。低密度脂蛋白胆固醇平均降低0.5 mmol/L，甘油三酯平均降低0.9 mmol/L，收缩压平均降低12 mmHg。药物处方节省显著；诺伍德手术每位患者每年用于糖尿病药物的平均花费为4.94英镑，而当地诊所为11.30英镑。截至2022年1月的一年中，诺伍德手术每年的花费比该地区平均水平少68353英镑。
描述了一种基于初级保健实现T2D缓解的实用方法。基于低碳水化合物饮食的方法能够实现显著的体重减轻，并带来巨大的健康和经济效益。它使整个诊所T2D患者群体中的20%实现了缓解。似乎糖尿病病程<1年是实现糖尿病无药缓解的重要机会窗口。该方法也能给那些可能无法实现缓解的T2D控制不佳患者带来希望，以HbA1c为代表，这一群体的糖尿病控制改善最为明显。
