As a man living with diabetes for 58 years, this is my personal opinion of a new age in diabetes. 

There is a new kid on the block, a paradigm shift in a formerly stagnant nutritional space: new clinical guidelines for the management of type 2 diabetes: ‘Therapeutic Carbohydrate Reduction (TCR) for Type Two Diabetes’, published in January 2024 and endorsed by the Australian Diabetes Society (ADS) and Diabetes Australia (DA).

People living with diabetes, like me, have endured and suffered through some 45 years of high carbohydrate national dietary advice.

I suggest such advice has harmed me, and I have sad memories of others whose deaths and suffering I recall or witnessed, some in their teens. Dietary authorities are implicated, not dietitians per se.  

And as a GP for 35 years, now retired, I remember many faces and many families stricken with grief. 

Discovering true science in properly performed studies, adopting my own very low carb diet, and learning from others’ lived experiences led me to realise what works for so many: the adoption of low and very low carbohydrate diets. Kindred spirits and understanding clinicians gave me heart. 

“Type 2 diabetes”, as experts repeat, “is a health condition defined by intolerance to sugar (carbohydrates)”. That these new guidelines oppose the basic tenets of the high carb diet espoused by the Australian Dietary Guidelines (ADGs) 2013 is an understatement. Such ADGs are outdated anyway – a review was due in 2023. 

Many are aware of the ADGs' failings. Researchers, doctors and others have criticised their recommendations, prompting some of the changes these new TCR guidelines herald.  

In 2015, the Australian Health Practioner Regulatory Agency (AHPRA) announced that doctors' prescriptions for low carbohydrate diets were safe and doctors' education about these diets was an acceptable practice. With rare exceptions, can any other dietary practice lead to a reversal of type 2 diabetes in up to 50% of those with the condition or prevent pre-diabetes or its progression? Or reverse diabetes-related complications in all types? And improve other measures of health through self-management, dietitians, general practitioners, credentialled nurses, medical specialists, or online membership service networks? 

The movement supporting low carb IS happening. What is needed now? In my opinion: 

1. Health ethics obligate all doctors, and possibly credentialled nurses and dietitians, to inform all current and newly diagnosed persons with diabetes (I would add those diagnosed with pre-diabetes, too) of these new guidelines—see, for example, AHPRA’s Good Medical Practice: a code of conduct for doctors in Australia—in 2.1, 3,1.5, 3.2.7, 3.2.13, 3.4.4, 4.3.1, 4.2.2, 4.2.6, 4.3.3, 4.5, 4.6.  
2. All current and newly diagnosed diabetics and their carers need to be made aware of their rights to proper and fully informed consent, and health institutions should be called out for policies promoting ADGs as the sole dietary therapy for people with diabetes of all ages.  
3. Training schemes for health professionals, now underway or planned, need better integration. They need to be checked for consistency and validated. They need to include input/presentations from those with long-lived experience of diabetes (all types) and of these types of diets. Do not doctors learn from their patients? 
4. Diabetes Australia and others must advise and coordinate with those with lived experience in patient education and all relevant health professions and agencies.  
5. Allowing for accurate indications and contraindications, no person should be disparaged or turned away for requesting to adopt these diets without an alternative referral. 
6. ADS must clarify its guidelines and management, allowing queries from all quarters, such as contraindications to use these diets or how type one diabetes fits into the guidelines.  
7. Discussion and decision-making on guidelines and education refinements must now include those with relevant long-lived experience with diabetes. For too long, people with diabetes, parents and carers have been excluded from or marginalised in such decisions when self-management is such a vital feature. 
8. Professional advice is required on the best business models for the training and education of health professionals, management and education for people with diabetes, and coaching and maintenance of dietary management. 

There is more to do, but this paradigm shift is a most welcome start.  

Dr Sangster received no pecuniary or material benefit from writing this opinion piece. Author's opinions are their own.