The diet that rewrote the rules on type 2 diabetes remission Clinicians have long treated type 2 diabetes as a progressive disease requiring increasing medication. But research from an NHS general practice in Southport challenged that assumption. An eight-year evaluation of a lower-carbohydrate diet with weight loss found that some patients could achieve drug-free remission. Its findings were published in the article, 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, 38 which subsequently became the most discussed paper ever published in BMJ Nutrition, Prevention & Health. For eight years, GPs and nurses at Norwood Surgery offered routine advice on a low-carbohydrate diet and weight loss to patients with type 2 diabetes, and tracked outcomes for 186 people against the practice's wider list of 9,800 patients. Among those who took up the approach, 51% achieved drug-free remission, rising to 77% among people diagnosed within the previous year. Average weight loss reached 10 kg, glycated haemoglobin (HbA1c) fell from 63 to 46 mmol/mol, and the surgery spent £68,353 less per year on diabetes drugs than the local average.
The paper's reach quickly outgrew the surgery. Written evidence submitted to the UK Parliament's Health and Social Care Committee inquiry into prevention cited it directly, quoting the study's remission rates, prescribing savings and average patient weight loss. It has since been included in a Royal Australian College of General Practitioners clinical handbook on managing type 2 diabetes, and fed into a 2025 update of an RCGP e-learning module on diabetes and glycaemic index, now free to all 50,000 UK GPs.
Audits like ours provide the external validity to answer questions a randomised controlled trial can't: how will this approach actually do in the NHS?” David Unwin, General practitioner and senior partner, Norwood Surgery, Southport, UK
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