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Verners Views: Comparison between the approaches to Type 2 Diabetes by Dr David Unwin and Diabetes UK 

Low-carb vs standard “diabetic diet”:

The most significant fact to emerge is that those who follow the advice of Dr [David] Unwin are so often successful.

In a paper published in 2016, Dr Unwin presents the results for 68 out of 69 patients who had completed an average of 13 months, in which they had complied with the lifestyle advice:

(1) Patient satisfaction was high from reports of feeling better and having more energy. Mean body weight fell by 9.0 kg, waist circumference fell by 15 cm, blood glucose (BG) control measured as HbA1c, fell by 10 mmol/mol or 19%, liver function measured as serum glutamyl transferase (GGT) improved by 39% and total cholesterol (TC) fell by 5%. Systolic and diastolic BPs dropped significantly too. Plasma triglycerides were not measured, but in common with prior observations for low-carbohydrate diets a significant improvement would have been anticipated.From the perspective of the practice, there has been a huge saving in the expenditure on drugs used for the treatment of diabetes. The actual figure is about £38,000 per year against the regional average, which represents the lowest spend per 1000 patients in any of the 19 surgeries in the surrounding Southport (UK) and Formby area for which information was available. This saving should be seen against the extra costs of the Norwood Surgery diabetes intervention at just under £9,000 per year.

(2) There has also been an improvement in the obesity prevalence as determined by BMI. This has dropped from 9.4% before the initiative commenced to 8.4%. The National Health Survey for England shows that for adults there has been a steady increase in the prevalence of obesity in England between 2010 and 2015 (Table 1).

Source: 305. A Comparison between the approaches to Type 2 Diabetes (T2D) by Dr David Unwin and Diabetes UK | Verners Views

RTWT for diet details.

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David Spero on Diabetes In the Workplace

Diabetes Self-Management has  good article to consider if you’re still in the workforce. To whet your appetite:

“Diabetes influences what jobs are best to work. Here are some things to think about:

• Regular schedules are best. Dr. Alan Glaseroff, a physician with Type 1 diabetes, says “Try to avoid shift rotation. It throws off your insulin, food, and exercise schedule.”

• Stressful jobs aren’t good, as stress raises blood sugar levels. In addition to emotional stress, stress can include physical hardship such as working in extreme cold or extreme heat.

• It’s important to be aware what kind of health insurance, if any, a job provides.• It is also important to know if breaks are allowed. Managing diabetes requires occasional breaks for checking blood sugar, eating, or take medication. A warehouse worker told me, “At my job, you get one paid break in nine hours. Most people skip the unpaid break and just keep working. My diabetes has been out of control since I started.”

• Larger companies might be better, because they are covered by worker-protection laws. The Americans with Disabilities Act (ADA) requires employers with over 15 workers to provide “reasonable accommodation” for disabilities, including diabetes.The Family Medical Leave Act (FMLA) assures that workers get unpaid time off for health needs such as doctor appointments and self-management training, but it only applies to companies with 50 or more employees within 70 miles of your place of work. According to San Francisco–based employee rights attorney Alan Adelman, jobs with union membership may provide an extra layer of protection.

Under the ADA, no employer of any size is allowed to discriminate against you, though small ones are not required to accommodate special needs.”

Source: Diabetes In the Workplace – Diabetes Self-Management

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At Healthline: Are There Really Five Subgroups of Diabetes?

Ginger Vieira has a short and sweet article at Healthline on the new proposed diabetes classification system you may have heard about. I’ll be surprised if the proposal gains any traction. If it does lead to helpful clinical management changes, we won’t see them for at least 5–10 years. A snippet:

Today there are four common types of diabetes: type 1 and type 2, latent autoimmune diabetes in adults (LADA), and gestational. And these classifications are plagued by an enormous amount of confusion, misconceptions, and even misdiagnosis between the types.

To complicate things further, a new study published in The Lancet Diabetes & Endocrinology is suggesting people with type 2 diabetes should be categorized into an additional four subgroups.

“This is the first step towards personalized treatment of diabetes,” said Leif Groop, a doctor and professor in the diabetes and endocrinology department at Lund University of Sweden.

Source: Are There Really Five Subgroups of Diabetes?

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Physicians Disagree On How Aggressively Diabetes Should Be Treated

If you’re a patient, you probably don’t like to hear this. You like to think that doctors have looked carefully at the appropriate scientific studies, understand  the underlying pathophysiology in detail, then reach a consensus on treatment. Sorry, but not in the case of diabetes. NPR has the story. For example:

A major medical association today suggested that doctors who treat people with Type 2 diabetes can set less aggressive blood sugar targets. But medical groups that specialize in diabetes sharply disagree.

Half a dozen medical groups have looked carefully at the best treatment guidelines for the 29 million Americans who have Type 2 diabetes and have come up with somewhat differing guidelines.

The American College of Physicians has reviewed those guidelines to provide its own recommendations, published in the Annals of Internal Medicine. It has decided that less stringent goals are appropriate for the key blood sugar test, called the A1C.

“There are harms associated with overzealous treatment or inappropriate treatment focused on A1C targets,” says Dr. Jack Ende, president of the ACP. “And for that reason, this is not the kind of situation where the college could just sit back and ignore things.”

The ACP, which represents internists, recommends that doctors aim for an A1C in the range of 7 to 8 percent, not the lower levels that other groups recommend.

Source: The American College of Physicians Recommends A1C Levels Between 7 And 8 Percent : Shots – Health News : NPR

I come down in favor of the lower HgbA1c values.

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Mediterranean Diet Shares Top Ranking With DASH Diet in U.S. News  and World Report

But they both have too many carbohydrates for most folks with diabetes. That’s why I created the Low-Carb Mediterranean Diet.

“Best Diets Overall are ranked for safe and effective weight loss, how easy it is to follow, heart health and diabetes help and nutritional completeness.”

Source: Best Diets Overall : Rankings | US News Best Diets

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DietDoctor’s Low-Carb Recipe Section: Not New, But Improved

That's a guacamole deviled egg

That’s a guacamole deviled egg

They’ve always been good recipes—with all-important nutrient analysis—but they’re even better now.

From DietDoctor:

“Our low-carb recipe site is probably already the most popular one in the world, with over 100,000 daily pageviews, several hundred recipes and gorgeous images. Now we’re adding even more great functions.You can now change the number of servings for recipes – the ingredient amount will correspond to the number of servings – and you can now also choose between the US or the metric measurement systems for ingredients. All to make it simpler to use our recipes.

We’ve also added a function for members so that it is now possible to save your personal favorite recipes. To activate the latter feature you need to be logged in, so that your selections can be saved for later.”

Source: The World’s Best Low-Carb Recipes Just Got Better – Diet Doctor

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Mediterranean Diet Could Prevent 20,000 Deaths Per Year in Britain

 

Italian seaside tangentially related to this post

Italian seaside tangentially related to this post

The Telegraph has the details:

“Some 20,000 lives could be saved each year if Britons switched to a Mediterranean diet, according to a new study.

The Medical Research Council (MRC) and Cambridge University followed nearly 24,000 people in the UK for up to 17 years to see how their diet affected the health of their heart.

They discovered that people who followed a diet high in fruits, vegetables, whole grains, nuts, fish and olive oil lowered their risk of cardiovascular disease by up to 16 per cent. The researchers estimate that 12.5 per cent of cardiovascular deaths, such as heart attacks and strokes,  could be prevented if everyone switched to the Mediterranean diet. There are around 160,000 heart deaths each year so 20,000 deaths could be avoided just by eating more healthy foods.”

Source: Mediterranean diet could prevent 20,000 deaths in Britain each year 

I’ve been a proponent of the Mediterranean diet for over a decade. I’m not alone.

Steve Parker, M.D.

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