Written evidence submitted by Dr David Unwin (PHS0017)

The nature of the issue that the Committee should explore

Three things all linked by poor diet

Pre-diabetes resolution, type 2 diabetes drug-free remission, obesity and weight loss

Who am I? Dr David Unwin FRCGP Royal College of General Practitioners clinical expert in diabetes I work at the Norwood practice in Southport near Liverpool (9800 patients). Since 1986 we have suffered a nine fold increase in the prevalence of T2D in the same population. We determined to do something about this by addressing the cause of the problem.

For ten years now we have been using an approach in our practice that results in significant published improvements in:

1. Pre-diabetes, 93% resolution (normal blood sugars) at about 2 years[1] 
2. 77% drug-free t2 diabetes remission of those people whose duration of diabetes was less than I year[2] this represents an important window of opportunity for patients. Overall, we achieved 51% remission at about three years for all patients adopting our approach. This currently represents 20% of our entire diabetic register. 127 proud individuals who have achieved diabetes remission[3] without needing drugs .
3. Diabetes drug-budget savings. Currently our NHS practice is saving £68,000 per year[2] because so many of our patients are not needing the lifelong medications usually needed.
4. Weight loss. The average weight loss for our patients is 10kg at about three years[2]
5. Blood pressure. The average improvement in systolic blood pressure was 10.9 mmHg[4]

What is our approach?

We help our patients improve their diet by avoiding the sugary and starchy foods that put blood sugar up in the first place.

Physiology and Psychology:

To do this we find it is key that people understand the physiology of both insulin and T2 Diabetes so they understand how to make appropriate changes to their diet that improve (lower) blood sugar. We have published some innovative ways to facilitate this[2].

We have a consultant clinical psychologist Dr Jen Unwin on the team because psychological approaches are key to both initiating and maintaining behaviour change. In particular we manage to harness the power of hope and supplying patient friendly feedback on progress. This maximises learning. We have published details here[5] and here[2]

Other UK practices are replicating our results look here[6] and here[7]

Another practice has developed a free APP using our approach; The Freshwell App. Ask me for details.

Around the world

We are working with an insurance company in North America -Level 2. These improvements can result in cheaper life insurance. An approach very similar to ours has been used successfully by the VIRTA group in California. They have published a lot on this [8]

Working with media 

We have helped with a BBC1 documentary ‘The truth About carbs’ and 30 separate pieces in The Daily Mail .The Times. The Express.

In conclusion only by preventing prediabetes and T2 Diabetes can we hope to cope with these illnesses. Just waiting until people are ill and using more and more expensive drugs can never be the answer. In our NHS GP practice of nine doctors and three nurses we have proved this can be done, for ten years now

February 2023

1.              Unwin, D., et al., Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years. BMJ Nutrition, Prevention & Health, 2020: p. bmjnph-2020-000072.

2.              Unwin, D., 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, 2023: p. e000544.

3.              Riddle, M.C., et al., Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetologia, 2021.

4.              Unwin, D.J., et al., Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care. International Journal of Environmental Research and Public Health, 2019. 16(15): p. 2680.

5.              Unwin D, U.J., A simple model to find patient hope for positive lifestyle changes: GRIN.Unwin D,Unwin J.Journal of holistic healthcare Volume 16 Issue 2 Summer 2019. Journal of holistic healthcare ● Volume 16 Issue 2 Summer 2019, 2019.

6.              Oliver, D. and K. Andrews, Brief intervention of low carbohydrate dietary advice: clinic results and a review of the literature. Current Opinion in Endocrinology, Diabetes and Obesity, 2021. 28(5): p. 496-502.

7.              Morris, E., et al., A food-based low-energy, low-carbohydrate diet for people with type 2 diabetes in primary care: a randomised controlled feasibility trial. Diabetes, Obesity and Metabolism, 2020. n/a(n/a).

8.              Hallberg, S.J., et al., Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther, 2018. 9(2): p. 583-612.