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

[Amity Island]

Nearly 5% of adults aged 30 years or older diagnosed with type 2 diabetes between 2004 and 2018 in Scotland went on to achieve type 2 diabetes remission for at least 1 year, according to study findings published in PLOS Medicine

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

Nearly 5% of adults aged 30 years or older diagnosed with type 2 diabetes between 2004 and 2018 in Scotland went on to achieve type 2 diabetes remission for at least 1 year, according to study findings published in PLOS Medicine. “History of never having glucose-lowering therapy, weight loss...

www.healio.com

 

[Alan S]

Sad that such a small percentage achieved remission. I am pleased they called it remission and not reversal, a word used so often by the snake oil sellers. Their definition of remission is interesting and rather tight:

Diabetes remission was defined as having an HbA1c of less than 6% without glucose-lowering therapy for at least 1 year before the data of the last recorded HbA1c in 2019.

 

[Christy]

It is depressingly low. Wonder if this is due to lack of ability/lack of education or apathy. Suspect it's a bit of all but we can see from this forum that GPs could definitely be more proactive. Perhaps they're jaded with the lack of patient uptake but all I got was "lose weight". Nothing else. No screenings/advice etc. Appreciate I was only just over the line but still....thank goodness for this site.

 

[Burylancs]

Nearly 5% of adults aged 30 years or older diagnosed with type 2 diabetes between 2004 and 2018 in Scotland went on to achieve type 2 diabetes remission for at least 1 year, according to study findings published in PLOS Medicine

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

Nearly 5% of adults aged 30 years or older diagnosed with type 2 diabetes between 2004 and 2018 in Scotland went on to achieve type 2 diabetes remission for at least 1 year, according to study findings published in PLOS Medicine. “History of never having glucose-lowering therapy, weight loss...

www.healio.com

Groans ! Yet another definition of 'remission' this time its hba1c of 6% (42) or under without 'glucose lowering therapy'. Is there any such thing as 'glucose lowering therapy', the usual suspects, metformin and gliclazide, are aimed at insulin. It seems that there are half a dozen definitions if this so-called 'remission' and you can just make it up as you go along. Why oh why don't they forget the fashionable fads and just talk about different strategies for achieving 'Good Control' ?

 

[Deleted member 21371]

It is depressingly low. Wonder if this is due to lack of ability/lack of education or apathy. Suspect it's a bit of all but we can see from this forum that GPs could definitely be more proactive. Perhaps they're jaded with the lack of patient uptake but all I got was "lose weight". Nothing else. No screenings/advice etc. Appreciate I was only just over the line but still....thank goodness for this site.

If you needed to lose weight, it's probably the best advice they can give you.
It's the most common advice given on this site normally.

 

[Deleted member 21371]

Groans ! Yet another definition of 'remission' this time its hba1c of 6% (42) or under without 'glucose lowering therapy'. Is there any such thing as 'glucose lowering therapy', the usual suspects, metformin and gliclazide, are aimed at insulin. It seems that there are half a dozen definitions if this so-called 'remission' and you can just make it up as you go along. Why oh why don't they forget the fashionable fads and just talk about different strategies for achieving 'Good Control' ?

There is a vast difference between reversal/remission and good control by a patients strategy.
If they stop the method of control, and BG rises, it was never in remission/reversal.

 

[Christy]

It's the most common advice given on this site normally.

If those 2 words ALONE is all the advice they give people no wonder success rates are low.

 

[Deleted member 21371]

IIf you needed to lose weight, it's probably the best advice they can give you.

If those 2 words ALONE is all the advice they give people no wonder success rates are low.

What other words would you add to someone newly diagnosed, looking to reverse diabetes and go back to a normal regime at the first appointment?

I believe you say you lost 4st 7lb to reduce your hba1c?
Kinda all everyone need to know?

 

[Christy]

Options for weight loss (low calorie/ reduced carb), existence of this forum, use of a meter, consequences of having diabetes, annual checks that should take place/ what an HbA1c means....not everyone is as lucky as I am to have stumbled on here and be able to do some research. Some/any of the above would have been helpful at diagnosis. Thankfully this site was very welcoming and informative.

 

[Deleted member 21371]

Options for weight loss (low calorie/ reduced carb), existence of this forum, use of a meter, consequences of having diabetes, annual checks that should take place/ what an HbA1c means....not everyone is as lucky as I am to have stumbled on here and be able to do some research. Some/any of the above would have been helpful at diagnosis. Thankfully this site was very welcoming and informative.

Yes, then you read the reports of a massive crash in hba1c, retinopathy problems, cholesterol shooting up, checking meter readings after every meal, worry over what is a perfectly normal rise in hba1c, panic over a perfectly normal dawn phenomenon, and pressure to move onto some diets and be locked into for life within the space of a first post.

Whereas I had excellent, but staged help from my HCP's.
(Personally I was too overwhelmed at my first appointment to actually take anything in really)
Over a period of around 18 months I lost 5 stone, by following a program agreed through various stages and courses with my team, I reversed my diabetes, and lead a normal life.
(Having said that, I do agree this site is helpful, and balanced, unlike the other quite potentially destructive (to me) site I accidently stumbled on initially!)
Horses for courses I guess

 

[Alan S]

What other words would you add to someone newly diagnosed, looking to reverse diabetes and go back to a normal regime at the first appointment?

I believe you say you lost 4st 7lb to reduce your hba1c?
Kinda all everyone need to know?

It is definitely not all that every newly diagnosed type 2 needs to know.

I lost significant weight when diagnosed after being given only that poor advice. Yes, weight loss helped a little but it was definitely not enough. My A1c only came down from 8.2% to 7.5%; that was back before the IFCC A1c numbers. The modern equivalent is 66 mmol/mol to 59.

It was not until I understood the importance of peak post-meal testing and applied it to improve my menu that I went under 6% (42) a year later.

 

[Deleted member 21371]

It is definitely not all that every newly diagnosed type 2 needs to know.

I lost significant weight when diagnosed after being given only that poor advice. Yes, weight loss helped a little but it was definitely not enough. My A1c only came down from 8.2% to 7.5%; that was back before the IFCC A1c numbers. The modern equivalent is 66 mmol/mol to 59.

It was not until I understood the importance of peak post-meal testing and applied it to improve my menu that I went under 6% (42) a year later.

I can't comment on what you heard when you where first diagnosed, and what you decided to do in the following year.
I personally went back to my HCP, worked with them, and we put a program in place together to eventually reverse my diabetes in that period.
If you just took the initial "poor advice" then didn't follow with them, I can only repeat that I did follow up, with great results.

 

[Amity Island]

Hi,

As a type 1, please could I ask, would anyone be kind enough to explain what it means to be in remission regarding type 2 diabetes?
Does remission mean you no longer have diabetes?
Does it mean it can come back?
What is type 2 diabetes?
What are the known reasons for getting type 2 diabetes?

I ask, because what started to look like an interesting discussion opened up on another thread that was subsequently locked.

Thanks

p.s please don't get this thread locked too!

 

[Deleted member 21371]

My known reason was I got fat.
When I lost weight, and reversed my weight gain, I reversed my diabetes.
I tend to view diabetes as similar to breaking a leg.
When it's fixed, it's fixed.
By fixed, I mean back to being just a normal leg, no cast, no crutches, just a perfectly normal leg.
Back to normal, unless I do the same thing again that broke it in the first place.
The legs not in remission, which I see as could snap again at any time while I was sitting down.
So, maybe if I get fat again, I can regain the diabetes, but I can't see me waking up with it one morning while I'm still thin, as that wasn't how I got it in the first place.

 

[Windy]

@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.

 

[Docb]

My known reason was I got fat.
When I lost weight, and reversed my weight gain, I reversed my diabetes.
I tend to view diabetes as similar to breaking a leg.
When it's fixed, it's fixed.
By fixed, I mean back to being just a normal leg, no cast, no crutches, just a perfectly normal leg.
Back to normal, unless I do the same thing again that broke it in the first place.
The legs not in remission, which I see as could snap again at any time while I was sitting down.
So, maybe if I get fat again, I can regain the diabetes, but I can't see me waking up with it one morning while I'm still thin, as that wasn't how I got it in the first place.

I can live with that @travellor and remission or reversal seems a good description for that subset of people diagnosed with diabetes for whom getting things under control has required losing weight and then maintaining the weight loss. You could go back to being diabetic by regaining the weight but that would take time.

Does not really work for those of us who are not overweight and have got things under control by reducing carb intake with pills and a bit or no weight loss. I reckon I could go back to diabetic in a couple of days simply by swapping out my diet to keep the calories the same but doubling the carbohydrate. A handful of dried fruit with every meal would probably keep my blood glucose in double figures in no time at all. It's for that reason I prefer to suggest my diabetes is under control and do not talk about reversal or remission as far as it is concerned. I look upon it as my pancreas being a bit dodgy for reasons unknown.

And here is the rub. A vast majority of those diagnosed with diabetes probably lie somewhere between those extremes with a bias, if there is one, being towards carrying excess fat. Because of that, many of those examined in Taylor's studies (other studies are available) will be overweight and will get "remission" if they lose it and maintain the loss. The danger is in generalising from the particular.

As I have suggested before I think the biggest problem is that although there is a precise protocol for defining whether an individual has diabetes it is all guess work when it comes to assigning the reason for poor glycaemic control. There is no protocol for determining whether for any individual it is due to insulin resistance from excess fat deposits or insulin deficiency from an underperforming pancreas, or a combination of the two. To my mind, it is that which leads both to the massive variability in the response that comes from primary care, and the confusion and argument that abounds when it comes to what ought to be a simple thing like definition of terms.

I am sure this discussion will not go away but it will only get anywhere if we appreciate all points of view have some merit and we try and edge towards consensus rather diverge into argument.

 

[everydayupsanddowns]

Hi,

As a type 1, please could I ask, would anyone be kind enough to explain what it means to be in remission regarding type 2 diabetes?
Does remission mean you no longer have diabetes?
Does it mean it can come back?
What is type 2 diabetes?
What are the known reasons for getting type 2 diabetes?

I ask, because what started to look like an interesting discussion opened up on another thread that was subsequently locked.

Thanks

p.s please don't get this thread locked too!

You might find this thread interesting @Amity Island

https://forum.diabetes.org.uk/boards/threads/intl-consensus-statement-on-definition-of-t2d-remission.95672/

Which includes links to the Diabetes UK position statement on T2 diabetes in post 11

In general Diabetes UK prefer the term ‘remission’ as it is not clear for how long any normalised glucose responses from the ‘rebooted’ pancreas will last - even if weight remains reduced.

The research is ongoing, and very promising, but we don’t have the duration of experience yet to be sure.

 

[Sharron1]

Hi,
My HCP insists on saying I have either reversed or am in remission from diabetes and every time my response is that my diabetes is well managed. Not quite sure why she finds that so difficult but she clearly does.

 

[Eddy Edson]

Hi,
My HCP insists on saying I have either reversed or am in remission from diabetes and every time my response is that my diabetes is well managed. Not quite sure why she finds that so difficult but she clearly does.

Maybe partly because of this:

In the UK, the state of being in remission is recognised by GP systems SNOMED code:703136005 (diabetes mellitus in remission (disorder)), permitting the individual to be declared non-diabetic (for insurance and all other matters) but with continuation of annual checks and NHS remuneration for diabetes care.

From Roy Taylor's info for doctors: https://www.ncl.ac.uk/media/wwwncla...centre/files/2020 Information for doctors.pdf

 

[everydayupsanddowns]

That’s interesting @Eddy Edson - good find!

In the past we have had members being told they are being ‘taken off the register’, which has caused confusion, because there isn’t really a specific ‘diabetes’ list/register kept aside from various diagnoses in people’s medical notes.

Reassuring to know that you can still access the all-important annual checks even if noted as being in remission.