Patient Profile:

• Name: KA
  
• Sex: Female
• Age: 60
  
• Medical History: Type 2 Diabetes Mellitus (T2DM), Adjustable Gastric Band (2002)
  Consultations: 52 between December 2015 and May 2025
  

Clinical Timeline:

• Dec 2015 – Sept 2018: Post-gastric band, KA maintained a weight between 83.9–89.3 kg (11–17% weight loss from peak 100 kg). Diabetes remained in remission.
  
  
• Sept 2018 – Jan 2019: Engaged with a low carb, healthy fat (LCHF) dietitian, reducing weight to 76.8 kg (23% weight loss).
  
  
• Dec 2019: Reintroduction of sugars and processed carbohydrates led to weight gain (83.4 kg) and metabolic deterioration: fasting glucose 7.9 mmol/L, fasting insulin 24 mU/L, HbA1c 5.9%. Initiated on metformin 500 mg/day and off-label empagliflozin (Jardiance) 10 mg/day.
  
  
• Dec 2019 – Aug 2020: Struggled with dietary adherence; weight increased to 87.4 kg. Experienced side effects from empagliflozin, leading to discontinuation. HbA1c rose to 6.3%, indicating a return of diabetes.
  
  
• Sept 2020 – Sept 2022: Faced challenges with sugar and carbohydrate cravings, resulting in weight fluctuations between 83.8–89.9 kg. HbA1c escalated to 7.1% by Sept 2022.
  
  
• Sept 2022 – Jan 2023: Commenced on liraglutide (Saxenda) for four months with minimal weight loss. Weight at Jan 2023 was 88.3 kg. Metformin dosage increased to 2000 mg/day.
  
  
• Feb – April 2023: Attempted the CSIRO low carb diet; however, the carbohydrate content remained too high for her insulin resistance. Weight remained around 88.9 kg. Introduced to Prof Peter Brukner’s book, The Diabetes Plan.
  
  
• May 2023: Enrolled in the Defeat Diabetes Program, weighing 88.2 kg.
  
  
• May 2023 – June 2024: Weight fluctuated between 86.9–89.1 kg. In June 2024, after viewing the “Diets: So Confusing” video from the program, further assessments revealed: fasting glucose 7.8 mmol/L, fasting insulin 13 mU/L, HbA1c 6.8%, and HOMA-IR 4.6 (indicative of significant insulin resistance).
  
  
• June 2024 – Jan 2025: Post-education on insulin resistance via the video “Insulin Resistance”, KA’s weight steadily decreased. By Jan 2025, weight was 83.4 kg. Discontinued metformin due to gastrointestinal side effects. Utilised a Continuous Glucose Monitor (CGM) for two months, aiding in dietary choices.
  
  
• May 2025: Achieved weight of 78 kg (22% total weight loss). Laboratory results indicated remission of diabetes and insulin resistance: fasting glucose 5.3 mmol/L, fasting insulin 7 mU/L, HOMA-IR 1.6, HbA1c 6%. KA reported feeling confident in her ability to manage her diet, weight, and metabolic health in the long term.
  

Insights:

KA’s journey underscores the complexities of managing T2DM and obesity, especially with concurrent sugar and carbohydrate cravings. Pharmaceutical interventions provided limited success. However, the Defeat Diabetes Program, with its evidence-based approach and educational resources, played a pivotal role in her transformation.

The Defeat Diabetes Program offers a comprehensive suite of resources, including concise videos by Dr Peter Brukner, an extensive library of 500+ recipes, weekly meal plans, and access to a supportive community. These features have significantly enhanced KA’s understanding of the relationship between diet and metabolic health. 

The HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) test is a valuable tool for identifying patients at risk of insulin resistance and associated chronic diseases such as type 2 diabetes and cardiovascular conditions.

Continuous Glucose Monitors (CGMs) provide real-time feedback on glucose levels, enabling patients to make informed dietary choices by illustrating the impact of different foods on their blood sugar.

This multifaceted approach has facilitated sustained behavioural changes in KA, leading to significant improvements in her metabolic health and weight management.

Conclusion:

This case exemplifies the challenges that GPs face in eliciting dietary changes in patients with type 2 diabetes mellitus (T2DM) and obesity. It also highlights the potential of educational programs, such as Defeat Diabetes, in supporting patients towards remission of their metabolic dysfunction.