28 June 2011
Crash Test Dummies?
I’ve read a few simplistic statements in my time but this one is right up there with the best. It aims to sum up a small study performed by one of our all-time heroes, Professor Roy Taylor of Newcastle and published in the Diabetologia Journal. In it, Professor Taylor found that an extreme diet of only 600 calories a day reversed the biomarkers in Type 2 diabetes to normal.
Brilliant, job sorted. What’s next then?
No, but seriously, if you read the small print there are many snags.
Clinical trials, almost by definition, are highly intensive. Patients on them have an enormous input from professionals to encourage and cajole them: the sort of input that is not possible in Slagthorpe* Primary Care Centre, for instance.
How many of your patients, if you gave them a diet sheet, would be able to keep to a 600 calorie a day diet? 2,000 is bad enough for most of ours!
Type 2 diabetes may take upwards of ten years to develop. To cure it in six weeks is not realistic. A return of biomarkers to normal does not equal a cure. If the diet is relaxed, surely the tests will return to their pre-treatment level.
Is diabetes curable? Many experts would argue that it is not. Even if the biomarkers are normal, it does not follow that diabetes has gone away. Patients still need monitoring for the foreseeable future.
One of my colleagues has Type1 diabetes for which, naturally, she takes insulin. She is very well controlled with an HbA1c of <6.0% in old money. This does not mean that she has not got diabetes anymore. If you stopped her insulin, she would still fall down with Diabetic Ketoacidosis as people with Type 1 Diabetes do.
By all means continue to advise your patients to eat and exercise in a healthy way but don’t, ever, discharge them from your diabetes clinic.
For more information on diabetes, why not register on our Diabetes Management in Primary Care distance learning course, which covers diet and exercise in great detail.
*How many of you remember Slagthorpe? Answers from those over 60 on a postcard please!