It is rather interesting that both the U.S. and U.K. guidelines, which are supposed to be followed by doctors, plainly mention the possible option to treat with diet/lifestyle alone. Yet, in both countries, it seems that option is seldom "prescribed" as an initial course of treatment by doctors, for those patients whom it might benefit. Or at least that is the impression I get.
An HbA1c target of 7% (53) is a ‘population’ level benchmark which is used to (1) assess the quality of long-term glycemic control and (2) to guide medication adjustment. 7% was chosen as studies have demonstrated that the vascular complications of diabetes occur above this level.
In the UK, the relevant targets are the NICE QOF targets:
https://www.nice.org.uk/standards-and-indicators/qofindicators?categories=&page=2, and in the US your physician is likely following the NCQA targets:
http://www.ncqa.org/programs/recognition/clinicians/diabetes-recognition-program-drp, based on the ADA best practice recommendations.
So, population level metrics are used in both the UK and the US to determine the quality of care a practice provides for their patients with diabetes; funding is always tied to achieving the quality metrics in both countries. The rationale being ‘why waste funding on ineffective care?’ Fair enough.
But, if population level metrics drive treatment decisions, then treatment will very quickly escalate if an individual fails to achieve the target HbA1c metric after 3 months of lifestyle interventions. Escalating treatment more or less guarantees that the target metrics will be met.
And, how much education and support is given to newly diagnosed patients, and what is the caliber of that education or support? It is important to remember that those of us who have managed to control our condition with lifestyle measures are outliers; we do not appear in the medical literature. Our physicians do not see many patients like us, they do not read about us in their journals. So, unless they are willing to take a radically different approach to management as Dr. David Unwin has done so successfully, they will escalate treatment according to the guidelines – so that their practice/surgery will achieve the quality metrics and be paid accordingly.
Is it any wonder that lifestyle measures get the short shrift?