SA JOURNAL OF DIABETES & VASCULAR DISEASE
EDITORIAL
VOLUME 11 NUMBER 1 • MARCH 2014
3
From diet to stem cell transplants
LANDI LOMBARD
Correspondence to: Dr Landi Lombard
Netcare Kuils River Hospital, Cape Town
Tel: +27 0(21) 900-6350
e-mail:
S Afr J Diabetes Vasc Dis
2014;
11
: 3
D
iet in the management of both type 1 and type 2 diabetes
has been extensively discussed and debated over many
decades. This topic has recently resurfaced and the
controversy is now more widespread than ever. It is surprising how
poorly studied such an important component of diabetes care is.
Currently, lifestyle modification is the second most potent therapy
in type 2 diabetes after insulin therapy, and it is more successful in
lowering HbA
1c
levels than any of the new therapies added in the
last 20 years.
The new interest in diet, especially for type 2 diabetes, was
created by none other than our own Prof Tim Noakes in his recent
book and numerous talks and interviews discussing the book. His
revolution, as he calls it, is not new and is similar to what Dr Atkins
promoted many decades ago but with a few modifications.
Noakes’ diet is based on high fat (and high protein) and very low
carbohydrate intake. It is not reinforced by a randomised trial but is
supported by his own success story as well as those of many other
well-known athletes. Undertaking randomised trials for prolonged
periods of time has proven difficult and enforcing compliance with
the diet over an extended period of time nearly impossible.
We will therefore not likely get good outcome data from
prospective, randomised trials, based on diet alone, lasting long
enough to give good statistical power. Therefore short-term weight
loss and perhaps glucose control are used as makers of success.
What we really want to know, however, is whether a specific dietary
adaptation will give survival benefit.
However the Noakes diet and book have spread like wildfire and
have become the discussion point of many dinner parties, braais and
evenmedical meetings. It is clear that many of my medical colleagues
are also on this diet and are losing weight very successfully. In my
own consultations in recent months, it has become one of the most
frequently asked and discussed topics by patients. Clearly this is a
revolution for which there is no scientific answer to claim or disclaim
its benefits and potential harms. Challenged at a recent talk, Prof
Noakes said that he and co-workers are trying to generate money
to undertake a randomised study incorporating his diet ideas. We
await these results with much anticipation.
In this edition of the journal, an article on high-protein diets and
renal disease raises one of the concerns of this kind of diet, but the
authors could not find any convincing evidence to dismiss the high-
protein diet, even in patients with known nephropathy. This article
includes a comprehensive literature review, which surprisingly also
lacked evidence of any detrimental effects of a high-protein diet.
Stem cell transplant has been a favourite topic of diabetologists
for many years and we were optimistic about a potential cure,
especially for type 1 diabetes. However, progress in real-life clinical
medicine and in making these transplants available has been
slower than originally anticipated and research is on-going. In a
comprehensive and detailed overview of the topic, Seewoodhary
and Evans discuss the different types of stem cell lines used as well
as their risks and potential benefits. We look forward to success in
this complicated procedure and hope for a cure for most patients
with type 1 diabetes in the not-too-distant future.
Hypoglycaemia also features prominently in this edition and this
challenging and under-diagnosed issue is discussed in two articles.
Hypoglycaemia is a threat to every patient with diabetes and a
frustration for every healthcare professional working with diabetics.
The first article by Inkster and Frier focuses on the impairment of
cognitive function due to acute hypoglycaemia in type 1 diabetes
patients. The other by Webb and Magan is on hypoglycaemia
unawareness, a real fear, especially for the diabetologist working
with patients with complicated type 1 diabetes. The review
deals with both the pathology and management of this difficult
problem.
The importance of infections, especially
Staphylococcus aureus
is discussed and reviewed in detail by Hakeem
et al
., based on
an interesting case presentation. All diabetologists will be faced
with this aggressive organism from time to time and will find the
knowledge discussed in this comprehensive review useful.
