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Type 2 diabetes medication de-prescription protocol published

By Editor
8th July 2019
Low carb, Low carb high protein diet Research Type 2 diabetes Type 2 diabetes remission

A paper providing guidance for de-prescribing type 2 diabetes drugs has been published.

The article Adapting diabetes medication for low carbohydrate management of type 2 diabetes: a practical guide has been published by the British Journal of General Practice.

The guidance has been produced in response to patients making significant health improvements as a result of following the Low Carb Program, an award-winning digital health programme that has been clinically demonstrated to improve glycaemic control and reduce hypoglycaemic medications in people with type 2 diabetes. Over 400,000 people have enrolled to date since November 2015.

Peer-reviewed, published health outcomes demonstrate patients with type 2 diabetes who complete the programme sustainably lose an average of 7.4kg at one-year and reduce HbA1c by 1.2%. Four in 10 people eliminate at least one medication and one in four people are classified as being in type 2 diabetes remission. 

The clinical definition of type 2 diabetes remission involves people having a HbA1c <6.5% (<48 mmol/mol) without antidiabetic drugs and being off all hypoglycemic medication. The protocol has been published to support the safe de-prescription of medication as patients adhere to a LCD such as the Low Carb Program.

In this new research, author Dr Campbell Murdoch said: “The pathological changes associated with type 2 diabetes (T2D) can be reversed through lifestyle measures, in some cases leading to remission. The low carbohydrate diet (LCD) is recognised as an effective option that is clinically inexpensive with few side effects.

“Many patients are achieving significant improvements in glycaemic control, with associated reduction in drug costs from cessation of hypoglycaemic agents. Digital-technology behaviour change solutions for T2D remission are being delivered at scale. Primary care clinicians need to be competent to adjust diabetes medications appropriately in individuals who follow an LCD.”

According to the paper, there are three key elements that are considered when looking at the safety of taking specific type 2 diabetes medications, alongside following a LCD. These are:

  • Is there a risk of the drug causing hypoglycaemia or other adverse event?
  • What is the degree of carbohydrate restriction?
  • Once carbohydrate is reduced does the drug continue to provide health benefit, and if so are the potential drug benefits greater than or less than possible risks and side effects?

Here is a table of type 2 diabetes medications which the researchers took into account as part of the study.

Medications that create a risk of hypoglycaemia

Medications that risk diabetic ketoacidosis

Treatments which pose no risk

  • Sulphonylureas and meglitinides
  • Insulins
  • SGLT2 inhibitors

  • Metformin
  • GLP-1 agonists (‘-enatide’, ‘-glutide’)

  • Thiazolidinediones (‘glitazones’)

  • DPP-4 inhibitors (‘gliptins’)

  • Acarbose

  • Blood glucose testing strips

In conclusion, Dr Murdoch said: “The LCD is an increasingly popular option for managing T2D that can lead to improvements in the condition, reduced medication burden, and (where needed) weight loss. Primary care clinicians need to be competent in adjusting diabetes medications to achieve safe and effective care.”

Dr Murdoch is Chief Medical Officer for Digital Diabetes Media, which provides the Low Carb Program.

To access the open source article, click here.

Picture credit: freestocks.org

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