Diabetes remission achieved by about 5% of adults with type 2 diabetes

[Amity Island]

@Amity Island Roy Taylor (one of the scientists behind the trials into remission) has put out multiple papers on it. This one is open access.

Does remission mean you no longer have diabetes? Taylor says remission, rather than no longer having it. Some of the people in his study regained T2 by putting weight back on.

Does it mean it can come back? Yes, if you regain the weight that made you diabetic in the first place

What is type 2 diabetes? Taylor's hypothesis is that you've gained more weight than your body can store and it stashes the excess fat into your liver and pancreas. This effectively gums the pancreas up and the beta cells stop making enough insulin eventually and lose their specialisation (I didn't really understand this part of the paper, but I guess they hunker down and stop making insulin?), whilst diet and the liver keep putting glucose into the blood. Losing weight "ungums" it and the beta cells wake up some time after you've lost 15% of the weight, as long as there are enough left working.

What are the known reasons for getting type 2 diabetes? Weight gain. You don't have to have a bigger BMI, or be visibly fat, but you have to be too fat for your body to cope, which varies from person to person. Taylor refers to this as a personal fat threashold.

More information here on the Newcastle university website Mike Lean at Glasgow university did the original study with him, and it was paid for by Diabetes UK.

Hi @Windy

Thanks for those answers, very interesting and succinct.

Can I ask then, if it is just a matter of weight loss, does this mean remission is possible for every (or just about) type 2 diabetic?

 

[Windy]

Hi @Windy

Thanks for those answers, very intersting and succinct.

Can I ask then, if it is just a matter of weight loss, does this mean remission is possible for every (or just about) type 2 diabetic?

I'm unsure. I vaguely remember in one of his books that there was remission in people who have had T2 for 25ish years, but the rate of remission declined over time. I will try and find the page in the book, but can't find it atm.

The Direct trial had participants who were "aged 20–65 years who had been diagnosed with type 2 diabetes within the past 6 years, had a body-mass index of 27–45 kg/m2, and were not receiving insulin".

and the trials being run in England are restricted to:
"be aged 18 – 65 years, have a diagnosis of Type 2 diabetes within the last 6 years, and have a BMI over 27 kg/m2 (or over 25 kg/m2 in people of Black, Asian or minority ethnic origin)"
so I guess they're the cohort of patients most likely to gain from it. I couldn't find any studies on an older age range, or people with a smaller BMI or an older diagnosis of T2.

Scotland NHS trusts seem to be offering it to T2s, but it doesn't say what the criteria is.

It looks like the English ones at least are trying to optimise the chance of remission in people who have been diagnosed in the last 6 years.

 

[Eddy Edson]

Hi @Windy

Thanks for those answers, very intersting and succinct.

Can I ask then, if it is just a matter of weight loss, does this mean remission is possible for every (or just about) type 2 diabetic?

The DiRECT trial results, at 12 and 24 months, showing percentage achieving remission by amount of weight loss sustained:



At 24 months, 70% of participants managing to sustain 15kg+ weight loss were in remission. What makes somebody a "non-responder" is I think an active area of research but the amount of time since developing T2D seemed to be a major factor. If you've had it for a long time you're chances of achieving remission via weight loss decrease.

The biggest issue IMO is the hard fact that weight loss is *really* difficult/impossible to sustain for many people, if not most. So eg even high rates of remission weren't enough to sustain almost half the people who lost 15kg+ at 12 months by month 24.

I'm pretty sure that the new, extremely effective weight loss meds will become an increasingly important part of T2D treatment over the next few years.

 

[Amity Island]

I'm unsure. I vaguely remember in one of his books that there was remission in people who have had T2 for 25ish years, but the rate of remission declined over time. I will try and find the page in the book, but can't find it atm.

The Direct trial had participants who were "aged 20–65 years who had been diagnosed with type 2 diabetes within the past 6 years, had a body-mass index of 27–45 kg/m2, and were not receiving insulin".

and the trials being run in England are restricted to:
"be aged 18 – 65 years, have a diagnosis of Type 2 diabetes within the last 6 years, and have a BMI over 27 kg/m2 (or over 25 kg/m2 in people of Black, Asian or minority ethnic origin)"
so I guess they're the cohort of patients most likely to gain from it. I couldn't find any studies on an older age range, or people with a smaller BMI or an older diagnosis of T2.

Scotland NHS trusts seem to be offering it to T2s, but it doesn't say what the criteria is.

It looks like the English ones at least are trying to optimise the chance of remission in people who have been diagnosed in the last 6 years.

Hi @Windy

Thanks for your replies @Windy , they are really useful and easy to understand.

I know this is a really simple question, but is there an approximate ratio of those over weight who develop type 2 diabetes?

.....and of course, those at a healthy weight who develop type 2 diabetes?

 

[Eddy Edson]

I couldn't find any studies on an older age range, or people with a smaller BMI ...

The follow-on ReTUNE trial is examining people with lower BMI's.

ReTUNEing type 2 diabetes remission

www.diabetes.org.uk

Prelim results were released a few months ago (not peer reviewed). See eg

Weight loss may help adults achieve type 2 diabetes remission, irrespective of BMI

Adults with normal weight and type 2 diabetes may be able to achieve diabetes remission with weight loss, according to data presented at the European Association for the Study of Diabetes virtual meeting. In an analysis of data from the ReTUNE trial, two-thirds of adults with diabetes and a BMI...

www.healio.com

In an analysis of data from the ReTUNE trial, two-thirds of adults with diabetes and a BMI of less than 27 kg/m2 were able to achieve diabetes remission after participating in a weight-loss intervention. The proportion was similar to those of previous studies analyzing diabetes remission with weight loss for people with overweight or obesity. Additionally, the study cohort had similar pathophysiologic changes during remission as previous studies showed for people with overweight and obesity.

 

[Burylancs]

Hi @Windy

Thanks for those answers, very intersting and succinct.

Can I ask then, if it is just a matter of weight loss, does this mean remission is possible for every (or just about) type 2 diabetic?

No the evidence, such as it is, suggests this ‘remission’ is only appropriate to a minority of type 2s i.e. fairly recently diagnosed. For example Prof Taylor, when he cherry picked suitable subjects for his 2017 experiment, excluded T2s dxed over 6 years ( his 2013 preliminary experiment had shown that his pet theory was irrelevant to them). Even then in his Lancet article describing his experiment he said that it was difficult for people dxed over 3 years to achieve his version of remission. Their condition had presumably progressed too far by then. In addition examination of insulin produced by Type2s showed that the insulin produced by up to 30% of us was malformed and lacked the tethers necessary to lock onto the insulin ports on the cell walls. And that was the cause of their insulin resistance, which in turn suggests talk of ‘remission’ is not relevant to up to 30% of T2s ( and might help to explain why Prof Taylor’s 2017 result was less than impressive - a 54% failure rate, rising to 64% after 2 years from the crash diet).
On top of that we have the 1990s explanation of diabetes which says you don’t get diabetes because you got fat, you get fat because you’ve got diabetes ( at least IR stockpiling unused glucose and insulin).
All the competing definitions of ‘remission’ ( bar one which allows Metformin use) are based on T2s not taking medication, implying that the only good T2 is one that is not taking medication. This seems to me to be obscurantist and irresponsible, unnecessarily spurning science and all the work done on T2 by great researchers over the last 100 years and the treasure trove of medication they have produced.
Overall the claim being made that Type 2 Diabetes can be put into ‘remission’ is an overblown, over-simplified generalisation which should be restricted to newly dxed T2s and hedged around with conditions including which guru’s definition of ‘remission’ is being used.When I was first dxed in 1992 it was commonplace to hear that even a 10% reduction in body weight would improve insulin resistance and bg control. So what’s changed - only the spin put on it.

 

[Windy]

Hi @Windy

Thanks for your replies @Windy , they are really useful and easy to understand.

I know this is a really simple question, but is there an approximate ratio of those over weight who develop type 2 diabetes?

.....and of course, those at a healthy weight who develop type 2 diabetes?

This paper says 90% of T2s are obese or overweight "Currently 90% of adults with type 2 diabetes are overweight or obese". It doesn't say if they were at diagnosis though, so I'm guessing somewhere around 10% are who are not overweight or obese, but it doesn't explicitly state that.

 

[Amity Island]

This paper says 90% of T2s are obese or overweight "Currently 90% of adults with type 2 diabetes are overweight or obese". It doesn't say if they were at diagnosis though, so I'm guessing somewhere around 10% are who are not overweight or obese, but it doesn't explicitly state that.

Thanks Windy,

And do you know what percentage of people (everyone) over weight are type 2? e.g If there are a million over weight people, how many of those go on to develop type 2 diabetes?

 

[Windy]

No the evidence, such as it is, suggests this ‘remission’ is only appropriate to a minority of type 2s i.e. fairly recently diagnosed. For example Prof Taylor, when he cherry picked suitable subjects for his 2017 experiment, excluded T2s dxed over 6 years ( his 2013 preliminary experiment had shown that his pet theory was irrelevant to them). Even then in his Lancet article describing his experiment he said that it was difficult for people dxed over 3 years to achieve his version of remission. Their condition had presumably progressed too far by then. In addition examination of insulin produced by Type2s showed that the insulin produced by up to 30% of us was malformed and lacked the tethers necessary to lock onto the insulin ports on the cell walls. And that was the cause of their insulin resistance.
On top of that we have the 1990s explanation of diabetes which says you don’t get diabetes because you got fat, you get fat because you’ve got diabetes ( at least IR stockpiling unused glucose and insulin).
All the competing definitions of ‘remission’ ( bar one which allows Metformin use) are based on T2s not taking medication, implying that the only good T2 is one that is not taking medication. This seems to me to be obscurantist and irresponsible, unnecessarily spurning science and all the work done on T2 by great researchers over the last 100 years and the treasure of medication they have produced.
Overall the claim being made that Type 2 Diabetes can be put into ‘remission’ is an overblown, over-simplified generalisation which should be restricted to newly dxed T2s and tempered with conditions including which guru’s definition of ‘remission’ is being used.

I don't see it that way @Burylancs, but I respect you have a different position.
It's not cherry picking to make the group you look at as homogeneous as possible, but it also means that you can only say that the study is pertinent to people with the same characteristics as those in the study group.
If I were studying what animals ate in the African savanna, I'd want to only look at lions, or giraffes, rather than lump them together, or I'd conclude at the end of my study that animals on the savanna eat meat and leaves, but lose the granularity of seeing that they are not all the same. It's normal to stratify samples so that you can work out what happens at each segment you're looking at and run statistical analyses on those segments.
I also don't see any judgement in the papers I've read that "the only good T2 is one that is not taking medication". They state the facts, dispassionately. I don't judge people if they do or don't medicate to manage their T2 (I'm on metformin, so it would be a bit weird if I did). Everyone's diabetes and it's management is up to them and their GP/medical advisors. There's no judgement from me, whatever works best for them.
It might be an over simplification that remission is possible, but it gave me a bit of hope when I was diagnosed. At best I might get it, at worst, I will have lost some weight, and that's a good thing, as I need to.
Best wishes, Sarah

 

[Amity Island]

No the evidence, such as it is, suggests this ‘remission’ is only appropriate to a minority of type 2s i.e. fairly recently diagnosed.

Hi @Burylancs

Thanks for your reply, very interesting indeed.

So, we could we have two different situations of recent diagnosis:

1. Where someone has been over weight for a long time and then develops type 2 diabetes
2. Where someone has had sudden weight gain and developed type 2 diabetes

Do they both have the same chance of remission?....if they lose weight to try and go into remission?

In other words, is it the duration of being over weight or the duration of the diabetes that effects chances of remission?

 

[Amity Island]

It might be an over simplification that remission is possible, but it gave me a bit of hope when I was diagnosed. At best I might get it, at worst, I will have lost some weight, and that's a good thing.

@Windy

I really liked that @Windy ! there is no harm in losing weight whatever happens in terms of remission. It's still a win for somebody if they lose some weight.

 

[Windy]

Thanks Windy,

And do you know what percentage of people (everyone) over weight are type 2? e.g If there are a million over weight people, how many of those go on to develop type 2 diabetes?

"Diabetes prevalence among adults who are obese

Analysis of combined Health Survey for England (HSE) data from 2010-12 show that 12.4% of people aged 18 years and over with obesity have diagnosed diabetes, five times that of people of a healthy weight."

Page 10 of the government paper I referenced earlier.

That doesn't answer your question, I tried searching via Google Scholar (which indexes scientific papers), but didn't find the answer. There was something in a blog but I haven't looked up all the references to see if they're reliable or not. They seem to be saying that it depends where your fat stores are deposited. If it's round your tummy and internal organs, you increase the risk of T2.

Sorry I couldn't find you a better answer than that.

 

[Deleted member 21371]

Well some interesting answers.
Too many to address individually.
So.
While there are different paths to being diabetic, many type 2's are overweight.
I lost around 50% of my body mass before I actually reversed my diabetes.
It seems to be a hysteresis loop.
Maybe fat goes onto the organs last, so I can put on weight, until - bang I was diabetic.
Maybe it comes off last, so I kept going until I reversed mine.
Maybe some thin type 2's have the issue of internal fat. A study of the amount of insulation swilling around in us would be interesting. I believe now I was less insulant resistant maybe, and more plugged up pancreas.
Insulation resistance is caused by "deformed" insulin. - Why do those that inject usually to inject a higher dose as type 2's? That can't be deformed if injected. But then that is different to a faulty pancreas for whatever reason.
There is also another post on here specifically about trialling a drug to help with insulin resistance, and nothing to do with altering the insulin used.
Losing weight works on newly diagnosed. - We were all that once, and from now on anyone diagnosed will be.

I agree there may well be many subsets of type 2's, but I think I was simply in the "fat at diagnosis" subset.
Certainly reducing carbs controls BG.
It would have reduced mine.
So yes, that probably is a catch all.
But my journey though diabetes wasn't looking for an ongoing intervention, be it medication, diet, or any other ongoing treatment.
it wouldn't have given me, personally, my life back.
And it was amazing how the weight had crept on over the years without me realising, so that reset was need as well.
I think there will be some interesting research and answers to type 2 coming at last, which is good to see

 

[Drummer]

I was told that I was overweight when I had a 24 inch waist - I was very muscular, but that was not taken into account - 45 years of being put on low calorie high carb diets and I was very overweight - almost spherical. I also was found to be diabetic.
All the symptoms I described are exactly right for loosing the first insulin response, but I was never checked for diabetes except when I was pregnant, decades ago, by urine dipping - but even when in the first months after diagnosis I never got a positive urine dip.
These days my reaction to carbs is exactly as it was - no longer diabetic but if I eat more than I can cope with, I put on weight around my middle and it takes some time to reduce down again.
I have sneering remarks on my medical notes - the GP left me alone with them once, so I read them - about my claims that diets don't work - well - for me, they don't - not the printouts which start off with cereal for breakfast and baked potatoes for lunch - but Atkins, now - that is entirely different.