I agree with all your points and have asked our (Diabetes UK local group) rep on the local CCG hcp and patient group to mention: T2 Rtn as a true first line of treatment (usually given lip service but undelivered) now that Taylor et al have a proof of the concept for shrinking visceral fat to achieve reversal quickly in most cases...The other methods (low carb, bariatric surgery and/or fasting are different ways of skinning that liver/pancreatic fat cat). NICE may go on to evaluate this dietary approach and I hope they will now also add low carb into that comparison with Low Fat and Mediterranean diets. Secondly, I believe there should be more honest conversations with patients about the overall risks of taking a medication versus nutrition approach. I saw my CCG guidelines in which the main criteria appeared to be ability to lower bgs and cost with little regard for the drugs' impact on diabetic co morbidiites. Patients assume that if they reduce their blood glucose with medication then this is just as cardio protective as doing it via diet and lifestyle and as far as I know this is not the case with most of the drugs and particularly insulin and S U s if no dietary changes are made. So if we can't rule the world we can start in our own surgeries and CCGs whose collboration we need to get the message out to the public.