Can you reduce risk of complications?

[Burylancs]

Moderator note: This discussion has been split away from an earlier thread to allow the original thread to stay on track

Congratulations on the great progress you have made @Stewpot@28 - you should feel very proud!

The weight loss and reduction in waist measurement may be particularly key, as it might indicate a reduction in visceral fat in the abdomen. Research has shown that for some people removing that visceral fat allows the pancreas and liver to function more effectively again (as long as the weight stays off), effectively ‘rebooting’ the metabolism. You may even find you have an increased capacity to process carbohydrates?

Interesting that your Dr used the term ‘reversed’. Diabetes UK tends to suggest the term ‘remission’ rather than ‘reversal’, as research in this area is still emerging, and it is currently not possible to say with certainty how long the improvements in glucose management without medication will last.

Type 2 diabetes remission

Type 2 diabetes remission is when your blood sugar levels return to a safe, non-diabetes level long-term, without the need for glucose-lowering medication. It stops diabetes in its tracks and boosts your chances of a healthy future. When you are in remission, you reduce the risk of diabetes...

www.diabetes.org.uk

“We don't call it 'reversing type 2 diabetes' like some people because remission isn’t a cure for type 2 diabetes. But when you’re in it, the symptoms of your diabetes are on pause, so is any new damage it can do to you. People in remission say it's life changing.”

'But when you’re in it, the symptoms of your diabetes are on pause, so is any new damage it can do to you.'

SUch extraordinary claims ! Not backed up by any cited evidence of course ! Even Taylor didn't track the impact of his research on complications ( which is always alluded to as one of the big weaknesses of his research of course). We simply have no idea how driving T2 into 'remission' by extreme measures what impact it has on CVD and CHD, the main complications and chief killers of T2s. Complications don't seem to respect Good Control.

THis just won't do from Diabetes UK, I know they've sunk £millions into this 'remission ' obsession, but statements from them as above need footnoted evidence fron two or three research papers.

 

[everydayupsanddowns]

There’s an update on the results from the DIRECT trial here, which may be helpful for the background behind the topic

Weight loss can put type 2 diabetes into remission for at least 5 years, DiRECT study reveals

UPDATE, 26 FEBRUARY, 2024: This article has been updated following new findings into our landmark DiRECT study which have been published in the Lancet. Results from a three-year extension of our landmark DIRECT study reveal that for some it’s possible to stay in remission of type 2 diabetes for...

www.diabetes.org.uk

Providing the weight loss is maintained, remissions from diabetes symptoms and a halting pf progression of the condition for those who responded to the direct intervention is now continuing for 5 years.

The direct trial also has its own website of course.

Complications don't seem to respect Good Control.

I’m not sure that is reflected in substantial bodies of evidence such as DCCT (diabetes control and complications trial), and UKPDS (the UK prospective diabetes study). There are no guarantees, of course, but effective management of different types of diabetes have been shown to substantially reduce the risks of long term complications.

Isn’t that why we all have glucose management targets?

 

[Burylancs]

There’s an update on the results from the DIRECT trial here, which may be helpful for the background behind the topic

Weight loss can put type 2 diabetes into remission for at least 5 years, DiRECT study reveals

UPDATE, 26 FEBRUARY, 2024: This article has been updated following new findings into our landmark DiRECT study which have been published in the Lancet. Results from a three-year extension of our landmark DIRECT study reveal that for some it’s possible to stay in remission of type 2 diabetes for...

www.diabetes.org.uk

Providing the weight loss is maintained, remissions from diabetes symptoms and a halting pf progression of the condition for those who responded to the direct intervention is now continuing for 5 years.

The direct trial also has its own website of course.



I’m not sure that is reflected in substantial bodies of evidence such as DCCT (diabetes control and complications trial), and UKPDS (the UK prospective diabetes study). There are no guarantees, of course, but effective management of different types of diabetes have been shown to substantially reduce the risks of long term complications.

Isn’t that why we all have glucose management targets?

1. Heh, heh, more statistical jiggery pokery from DiRECT of course, a classic trait of 'Bad Science'. The 23% of 36% at the two year mark meant that only 8% were in 'remission' at the 5 year mark and 92% were not. It's another Logical Fallacy - Survivorship Bias - where only the 8% who support Taylor's idea count and the 92% who prove him WRONG are ignored or as usual with T2s blamed for their own condition.
2. Don't cite UKPDS. It's claim that Good Control reduced the risk of complications by 22% was exposed by Ben Goldacre as Bad Science. Four complications were studied and then the results aggregated and averaged out. So it turns out Good Control reduced retinopathy by 83 %. The other complications ( heart disease, neuropathy, kidneys ) were reduced by figures like 2% and 1%. Add them all together you get 88%, divide by 4 and hey presto, Good Control reduces complications by 22% . When in reality, and disappointingly, it does Jack Squat for major complications.

A lot of what surrounds Type 2 Diabetes is the chop logic of 'the man on the Clapham Omnibus' - if you reduce fat in the pancreas long dead Beta Cells must spring back into life like Lazarus, surely ?'

 

[PerSpinasAdAstra]

A lot of what surrounds Type 2 Diabetes is the chop logic of 'the man on the Clapham Omnibus' - if you reduce fat in the pancreas long dead Beta Cells must spring back into life like Lazarus, surely ?'

Dead beta cells and dysfunctional beta cells aren't the same thing though, surely. Nobody is suggesting that weight loss reverses permanent pancreatic damage, though there's plenty of indication that it's possible to restore living beta cell function, at least partially, and that getting fat out of the pancreas and keeping it out is likely key to enabling some functional restoration. Would you argue that it's not even worth trying if only 8%, or even half that, achieve five years of remission with the potential for some recovery of beta cell function? When trying is as simple as losing weight, with all the other health benefits that brings?

 

[Robin]

Don't cite UKPDS. It's claim that Good Control reduced the risk of complications by 22% was exposed by Ben Goldacre as Bad Science. Four complications were studied and then the results aggregated and averaged out. So it turns out Good Control reduced retinopathy by 83 %. The other complications ( heart disease, neuropathy, kidneys ) were reduced by figures like 2% and 1%.

So you’re basically saying we may as well all pack up and go home, (apart from saving one’s eyesight). Assuming this to apply to Type 1 as well as Type 2, in both cases we've always been told it’s the higher BG that does the damage, have all the doctors and consultants been wrong all this time?

 

[Docb]

If I can chip in..... @Burylancs , I think you have a bit of a point in your thesis that the way some of the numbers are used and interpreted are stretching the limits of what is robust when vested interests are out to promote the success of a trial. I would however suggest that condemning the work by being equally cavalier with interpretation of the data is just as bad.

Your comments on the trials seem to be saying that there is no value in them at all. Is that what you really believe?

And @Stewpot@28 - Nice work and well done. Whatever you think about the quality of the trials, you have demonstrated that the basic principle of losing weight if you are overweight is a good place to start if you get a T2 diagnosis. Worked for you and is likely to work for a lot of others.

I also think you are bang on with your comment that

"My goal now is to keep up this lifestyle and not fall off the wagon"

Does not matter whether you claim you have control, reversal or remission, chances are that if you put the weight back on your diabetes will be back where you started from. And that thought does not come from any trial - just read around the forum and you will get that impression from what members tell us.

 

[harbottle]

It's been thought for a while that dedifferentiated beta cells recover from glucotoxicity and start working again when the stress is reduced. It's also been known for a while that the mass of beta cell loss doesn't really account for the lack of insulin that leads to T2D.

While some cells have undergone a process of apoptosis, others are 'de-differentiated' and no longer respond to the blood sugar rises.

The other toxicity that causes beta cells to stop working is lipotoxicity.

 

[Burylancs]

1. Heh, heh, more statistical jiggery pokery from DiRECT of course, a classic trait of 'Bad Science'. The 23% of 36% at the one year mark meant that only 8% were in 'remission' at the 5 year mark and 92% were not. It's another Logical Fallacy - Survivorship Bias - where only the 8% who support Taylor's idea count and the 92% who prove him WRONG are ignored or as usual with T2s blamed for their own condition.
2. Don't cite UKPDS. It's claim that Good Control reduced the risk of complications by 22% was exposed by Ben Goldacre as Bad Science. Four complications were studied and then the results aggregated and averaged out. So it turns out Good Control reduced retinopathy by 83 %. The other complications ( heart disease, neuropathy, kidneys ) were reduced by figures like 2% and 1%. Add them all together you get 88%, divide by 4 and hey presto, Good Control reduces complications by 22% . When in reality, and disappointingly, it does Jack Squat for major complications.

A lot of what surrounds Type 2 Diabetes is the chop logic of 'the man on the Clapham Omnibus' - if you reduce fat in the pancreas long dead Beta Cells must spring back into life like Lazarus, surely ?'

So you’re basically saying we may as well all pack up and go home, (apart from saving one’s eyesight). Assuming this to apply to Type 1 as well as Type 2, in both cases we've always been told it’s the higher BG that does the damage, have all the doctors and consultants been wrong all this time?

Do you remember the ACCORD study of 2008 ? The uproar it caused at the time ? That tight glucose control in T2 was associated with an increase in microvascular problems and all-cause mortality.

 

[childofthesea43]

That trial was conducted on people who already had significant cardiovascular problems, and their glucose was lowered using drugs. Its finding do not translate to those who have not yet got such problems and have achieved remission without the use of drugs.

 

[Robin]

Do you remember the ACCORD study of 2008 ? The uproar it caused at the time ? That tight glucose control in T2 was associated with an increase in microvascular problems and all-cause mortality.

No I don’t, because I was only diagnosed in 2007and was busy getting to grips with my condition. I’ve just had a quick whip through, and discovered the following.
1)The participants all had cardiovascular disease, or the older ones had markers for it, such as atherosclerosis and or smoking, and
2) They had far more hypos while they were being intensive.y treated on the study.
All it says to me, is that if you take a group of people with heart disease and give them hypos, it’ll kill some of them.

Edit: @childofthesea43 types faster than I do!

 

[Bruce Stephens]

Do you remember the ACCORD study of 2008 ?

I don't, but a quick search provides this summary (which is rather unusual) https://academic.oup.com/jcem/article/97/1/41/2833135

The primary outcome of cardiovascular disease (CVD), a composite of CVD death, non-fatal myocardial infarction and non-fatal stroke was not reduced by either of the intensive strategies or by addition of fenofibrate; moreover, total mortality was increased by the intensive glycemic strategy. Some secondary CVD outcomes were benefited as were some secondary microvascular outcomes by the more aggressive treatments. Epidemiological analyses were perplexing: for example, earlier severe hypoglycemic episodes were a risk factor for mortality and occurred three times as often in the intensive glycemic treatment group, but the excess of deaths in that group was not accounted for by those subjects who had suffered earlier episodes of severe hypoglycemia.​

All it says to me, is that if you take a group of people with heart disease and give them hypos, it’ll kill some of them.

It looks like the hypos don't explain the excess in deaths. (Or they don't think they do.)

 

[childofthesea43]

No I don’t, because I was only diagnosed in 2007and was busy getting to grips with my condition. I’ve just had a quick whip through, and discovered the following.
1)The participants all had cardiovascular disease, or the older ones had markers for it, such as atherosclerosis and or smoking, and
2) They had far more hypos while they were being intensive.y treated on the study.
All it says to me, is that if you take a group of people with heart disease and give them hypos, it’ll kill some of them.

Edit: @childofthesea43 types faster than I do!

Of course, childofthesea43 is just a bot.

 

[harbottle]

That trial was conducted on people who already had significant cardiovascular problems, and their glucose was lowered using drugs. Its finding do not translate to those who have not yet got such problems and have achieved remission without the use of drugs.

Yes, and the other criteria for inclusion was being obese or a smoker.

That paper also found long term benefits in the group that underwent intensive treatment - and they admit the results may be due to other factors such as interaction between the intensively used drugs.

 

[Gwynn]

Ok maybe the science is a bit iffy but from my own sample of me, that's 100% of those involved in the trial, remission achieved whilst on no meds, significant weight loss and reduced carb diet. Although the rediagnosis of 'in remission' was only given a few months back after 3 years in unofficial remission, it is real.

There maybe something of value in what is being stated by the researchers.

Are we sometimes too quick to dismiss new/alternate things where there could be good there to see or even hidden within the research?

I didn't change everything at the start of my journey because of any research but because of a fellow hospital inmate who gave me some very good but limited information that gave me a starting point. This forum then became my source of information, correction, help. Then the real hard work of delving into the internet and trying to sieve out the mis-information.

I tend to try to look at these things with as open a mind as possible.

I think it is great that there are people out the giving their time, effort and thoughts on our behalf (whatever their motives).