Sep 15th 2017

GPs need to tell people they can get rid of type 2 diabetes through weight loss – nutrition expert

by Mike Lean

Chair of Human Nutrition, University of Glasgow

Every working day, GPs in the UK diagnose almost 1,000 people with type 2 diabetes. It is one of the commonest and most expensive diseases. What most people don’t know is that with a bit of hard work, it is possible to become non-diabetic again.

Formerly limited to older people, type 2 diabetes is now common in younger, fatter, people in their 40s and 50s, and even younger ones who are severely obese. Some people are spared, but the epidemic of diabetes has closely followed the epidemic of overweight and obesity. The key is where the excess fat is stored: if it can no longer be stored under the skin, and starts to accumulate in the liver and pancreas, these organs malfunction to cause diabetes.

The conventional conversation with a GP used to go: “Your blood test confirms that you have diabetes.” And then, “Don’t worry, it’s mild diabetes and we can treat it with tablets.” That advice is horribly wrong.

Patients deserve a fuller, more honest explanation: “You are right to be concerned. Type 2 diabetes is a ghastly, progressively destructive disease. It leads to disabling painful complications, as the main cause of amputations, blindness and kidney failure, and contributes importantly to heart disease and dementia. Oh, and the tablets reduce your blood glucose but allow the disease to progress, so you will still die five to eight years younger.”

We now hope to add: “But if we can help you with an evidence-based programme to lose a substantial amount of weight, often 15kg or more, there’s a good chance you will no longer be diabetic.”

Losing 15kg often does the trick

A growing number of people who develop type 2 diabetes have decided that they don’t want to live with this stigmatising disease or wait for its complications. By one means or another they have managed to lose weight – commonly 15kg or more – so they become non-diabetic again. They no longer carry the disease-label, or need the tablets, or pay the increased insurance premiums. Their blood pressure comes down, sleep apnoea (a cause of depression) improves and they often feel younger and more energetic.

Knowing this, research teams in Glasgow and Newcastle are running the Diabetes Remission Clinical Trial (DiRECT). It will establish how many people with type 2 diabetes can lose 15kg or more and achieve a remission, and for how long.

More than 300 people with type 2 diabetes, in Scotland and Tyneside (England) are involved. The treatment uses a well-established weight-management programme, which involves a 12-week total diet replacement phase, followed by stepped, structured food reintroduction phase, followed by a weight maintenance phase. This programme is delivered entirely within routine NHS primary care, so the results should be applicable to almost all people with the disease.

It is designed to find out if over one in five people with type 2 diabetes can get rid of their diagnosis (off all anti-diabetes drugs) after one year. That sort of number would have massive implications for healthcare spending.

In principle, if people are no longer diabetic, they can’t get the complications of diabetes. However, at present, diabetes researchers and healthcare planners can’t get reliable information to confirm that, because doctors are not recording the remissions by using the appropriate code in national statistics, in the UK, US and elsewhere.

In a recent article in the BMJ, my colleagues and I called on UK doctors to start to record when their patients achieve remission of diabetes.

GPs in the UK are rewarded with practice payments for recording that they have made a diagnosis of diabetes, and then for prescribing drugs for it. Recording remission, however, is extremely rare, perhaps because doctors fear that their payments might cease. In fact, if the correct code is used, those payments will continue, but they actually deserve a much greater reward if they can help their diabetic patients achieve remission, and save the NHS the costs of the drugs and the complications.


This article was originally published on The Conversation. Read the original article.

Browse articles by author

More Essays

Tear them down? “White Jesus” statues have an Unsavory History in Aryan Racial Theory that also Influenced Nazi Theology
by Juan Cole
Jun 27th 2020
An essay about the "the enormously influential 1940 'Head of Christ' painting by evangelical Warner E. Sallman" pictured below.
Gut health: does exercise change your microbiome?
by Rachael Rigby and Karen Wright
Jun 17th 2020
EXTRACT: "The diverse, non-human life forms that live in our guts – known as our microbiome – are crucial to our health. A disrupted balance of these contribute to a range of disorders and diseases, including obesity, diabetes, inflammatory bowel disease. It could even affect our mental health..... It’s well known that the microbes living in our guts are altered through diet. For example, including dietary fibre and dairy products in our diets encourages the growth of beneficial bacteria. But mounting evidence suggests that exercise can also modify the types of bacteria that reside within our guts."
Dietrich Bonhoeffer and Today’s Movement for Racial Justice
by Sam Ben-Meir
Jun 13th 2020
EXTRACT: "Bonhoeffer’s life holds an important lesson for us today, regardless of our religious affiliation or lack thereof. And simply put it is this: you are called upon; you are called on behalf of your neighbor. When you are called to be responsible that is not an obligation which you can decline, discharge or acquit yourself of – it is an infinite responsibility, a “forever commitment” as Charles Blow recently put it. And we all must be prepared to make any sacrifice necessary when we are called."
How sensitive you are may be partly down to your genes – new research
by Elham Assary and Michael Pluess
Jun 11th 2020
EXTRACT: "People differ substantially in how much they’re affected by experiences in their lives. Some people seem to be more affected by daily stress, or the loss of someone close to them. On the other hand, some people seem to get through the same experiences relatively unscathed. Similarly, some people benefit strongly from counselling, or having a support system of close family and friends. Others seem better able to manage on their own. But understanding why some people are more sensitive than others isn’t just a question of how they were raised, and the experiences they’ve been through. In fact, previous research has found that some people in general seem more sensitive to what they experience – and some are generally less sensitive."
What Can Hegel Teach Us Today?
by Sam Ben-Meir
Jun 7th 2020
EXTRACT: " The root causes of anthropogenic climate change – which has led to the endangering of countless species across the globe – cannot be adequately grasped in isolation from the technological application of modern science. While Swedish activist Greta Thunberg was certainly justified in calling upon American legislators to “unite behind the science,” neither can we overlook the culpability of science in bringing about the environmental crisis. "
The Church of QAnon: Will conspiracy theories form the basis of a new religious movement?
by Marc-André Argentino
May 23rd 2020
EXTRACT: "The QAnon movement began in 2017 after someone known only as Q posted a series of conspiracy theories about Trump on the internet forum 4chan. QAnon followers believe global elites are seeking to bring down Trump, whom they see as the world’s only hope to defeat the “deep state.” OKM is part of a network of independent congregations (or ekklesia) called Home Congregations Worldwide (HCW). The organization’s spiritual adviser is Mark Taylor, a self-proclaimed “Trump Prophet” and QAnon influencer with a large social media following on Twitter and YouTube."
How non-religious worldviews provide solace in times of crisis
by Valerie van Mulukom
May 23rd 2020
EXTRACT: "The aim of my research for the Understanding Unbelief programme was to investigate the worldviews of non-believers, since little is known about the diversity of these non-religious beliefs, and what psychological functions they serve. I wanted to explore the idea that while non-believers may not hold religious beliefs, they still hold distinct ontological, epistemological and ethical beliefs about reality, and the idea that these secular beliefs and worldviews provide the non-religious with equivalent sources of meaning, or similar coping mechanisms, as the supernatural beliefs of religious individuals."
Why people believe that religious faith will save them from disease
by Rebecca Yearling
May 22nd 2020
EXTRACT: "Psalm 91, for example, reassures believers that God will protect them from “the pestilence that walketh in darkness… A thousand shall fall at thy side, and ten thousand at thy right hand; but it shall not come nigh thee”.............Luther was a devout believer but insisted that religious faith had to be joined with practical, physical defences against sickness. It was a good Christian’s duty to work to keep themselves and others safe, rather than relying solely on the protection of God. "
Dementia: eating plenty of apples, berries and tea linked to lower risk – new research
by Eleftheria Kodosaki and Keith Morris
May 22nd 2020
EXTRACT: "Evidence from this study shows clearly that eating foods rich in flavonoids over your lifetime is significantly linked to reducing Alzheimer’s disease risk. However, their consumption will be even more beneficial alongside other lifestyle changes, such as quitting smoking, managing a healthy weight and exercising."
Values in the age of coronavirus: how a disease changed what it means to live a virtuous life
by Kevin Morrell
May 5th 2020
EXTRACT: "It’s possible that the answers to questions like, “how do I live a virtuous life?” or “how do we build a good society?” are not the same as they were a few weeks ago."
Strong opinions are irrational – here’s why we should all be agnostic
by Darren Bradley
May 2nd 2020
EXTRACT: "Strangely, those with strong beliefs tend to be admired. The human mind hates uncertainty, so it is comforting to be told what to think, and to form settled opinions. But it is not rational. As the philosopher Bertrand Russell wrote: “The fundamental cause of the trouble is that in the modern world the stupid are cocksure while the intelligent are full of doubt.”
How the rich reacted to the bubonic plague has eerie similarities to today's pandemic
by Kathryn McKinley
Apr 21st 2020
Extract: "Humans, Boccaccio seems to be saying, can think of themselves as upstanding and moral – but unawares, they may show indifference to others. We see this in the 10 storytellers themselves: They make a pact to live virtuously in their well-appointed retreats. Yet while they pamper themselves, they indulge in some stories that illustrate brutality, betrayal and exploitation. Boccaccio wanted to challenge his readers, and make them think about their responsibilities to others. “The Decameron” raises the questions: How do the rich relate to the poor during times of widespread suffering? What is the value of a life? In our own pandemic, with millions unemployed due to a virus that has killed thousands, these issues are strikingly relevant.
The Theology of Pandemics
by Sam Ben-Meir
Apr 20th 2020
Extract: "If we do not seize this crisis as a moment for transformation, then we will have lost the war. If doing so requires reviving notions of collective guilt and responsibility – including the admittedly uncomfortable view that every one of us is infinitely responsible, then so be it; as long we do not morally cop out by blaming some group as the true bearers of sin, guilt, and God’s heavy judgment. A pandemic clarifies the nature of action: that with our every act we answer to each other. In that light, we have a duty to seize this public crisis as an opportunity to reframe our mutual responsibility to one another and the world."
Five things coronavirus can teach us about life and death
by Tony Walter
Apr 16th 2020
EXTRACT: "Death is the common experience which can make all members of the human race feel their common bonds and their common humanity."
Social Crisis and the Public Use of Reason
by Sam Ben-Meir
Apr 7th 2020
EXTRACT: "A crisis such as this one demands that we exercise what the philosopher Immanuel Kant called the ‘public use of reason’ – as opposed to merely the ‘private use of reason’ where, briefly put, the expert, the specialist is tasked with resolving a defined problem. The private use of reason is sufficient when we are dealing with a problem that can be solved by simply applying the appropriate expertise...............The public use of reason asks: how we are defining the problem? Is our definition – our conceptualization of the problem – perhaps part of the problem itself? Is this pandemic solely a problem of public health, or is it also a problem of extreme economic inequality? ..............Since this crisis began, the greatest failure of the administration is not the denial, the lies, the lack of preparedness, but the inability to rally and unify the nation against this common threat, the lack of genuine leadership – Trump’s utter inability to bring the nation together."
Book review: The debate over an architectural masterpiece
by Michael Johnson
Apr 5th 2020
EXTRACT: "Rarely has an architectural experiment aroused such extremes of ire and admiration. One side is convinced the house is a masterpiece. The other expresses brutal condemnation of the entire project (leaky roof, danger of flooding, too-hot, too-cold interiors depending on the American Midwest weather).........Farnsworth encapsulated her personal ambiguity in her comment to a Newsweek interviewer: “This handsome pavilion I own is almost totally unworkable.” She told one journalist, “ … all I got was this glib, false sophistication. The conception of a house as a glass cage suspended in air is ridiculous.”
How pandemic shattered the harmony of medieval Europe’s diverse cities
by Miri Rubin
Apr 1st 2020
Ambrogio Lorenzetti, Effects of Good Government fresco, Palazzo Pubblico, Siena.
Coronavirus: what philosopher Immanuel Kant can teach us about panic buying and isolation dodging
by Matthew Barnard
Mar 29th 2020
EXTRACT: "The coronavirus crisis has forced us to look at our behaviour in a way that we’re not used to. We are being asked to act in the collective good rather than our individual preservation and interest. Even for those of us with the best of intentions, this is not so easy."
‘The bills were more stressful than the cancer’: US versus UK healthcare – a personal story March 20, 2020 1.56pm GMT
by Nora Groce
Mar 23rd 2020
EXTRACT: "In March 2020, my sister Nancy and I did something that, as scholars, we had never done before: we wrote about ourselves, comparing our own experiences receiving cancer care on either side of the Atlantic. As we recently reported in the BMJ, much of our experience is similar. As twins, we both have the same form of cancer. Both of us received excellent treatment in well-established university teaching hospitals. Both of us are now in remission. But there is a glaring difference. Nancy lives in the US, covered under a good private healthcare scheme. I live in the UK, covered by the NHS."
Philosopher in Italian coronavirus lockdown on how to think positively about isolation
by Silvia Panizza
Mar 21st 2020
EXTRACT: "In philosophy, individualism is closely linked with the concept of freedom. As soon as restrictive measures were imposed in Italy, many people felt that their freedom was threatened and started to assert their individuality in various ways. Some disagreed with the necessity of cancelling group gatherings and organised unofficial ones themselves. Others continued to go out and live as they always did. We often assume that freedom is to do as we choose, and that is contrasted with being told what to do. As long as I am doing what the government tells me, I am not free. I am going out, not because I want to, but because that shows I am free. But there is another route to freedom..........."