Ditched Metformin

[everydayupsanddowns]

2 weeks ago 500mg per day, and my pre breakfast readings have not risen above 7.1. So far so good

Sounds like you are keeping a close eye on things, and personalising your approach @Anto

The data I’ve seen about T1 suggest that the long-term health benefits below 48, while they do exist, are significantly ‘levelling out’ and need to be balanced with whatever effort (and possible risks) might be involved in attempting to achieve it.

Prof Taylor’s research in T2 suggests maintaining 48mmol/mol with no medication as diabetes being ‘in remission’

 

[JITR]

Prof Taylor’s research in T2 suggests maintaining 48mmol/mol with no medication as diabetes being ‘in remission’

I am sure you will find Prof Roy Taylor's Counterpoint study found responders' HbA1c levels came down to 42 or less, thus reducing the cardiovascular risks and elevated levels associated with prediabetes. I will post a graph showing the results later.

 

[JITR]

I am sure you will find Prof Roy Taylor's Counterpoint study found responders' HbA1c levels came down to 42 or less, thus reducing the cardiovascular risks and elevated levels associated with prediabetes. I will post a graph showing the results later.

Ando asked what remission looks like:



The graph comes from Figure 4 in Type 2 diabetes and remission: practical management guided by pathophysiology Responders are represented by solid circles. I have added the horizontal line at HbA1c 6% (42 mmol/l) to show the responders BG returned to normal levels without medication (withdrawn on day 1 of the study).

Quote: "... with beta‐cell capacity to recover being determinative for remission of type 2 diabetes."

Fortunately, a finger prick of 5.8 mmol/l on New Year's Eve 2022 showed I was a responder myself.

 

[everydayupsanddowns]

I am sure you will find Prof Roy Taylor's Counterpoint study found responders' HbA1c levels came down to 42 or less, thus reducing the cardiovascular risks and elevated levels associated with prediabetes. I will post a graph showing the results later.

Indeed. But Direct set the bar at 48mmol/mol or lower on no meds as I understand it?

From the protocol:

Co-primary endpoints:

• Reduction in weight of 15 kg (assumed equal on average to 15 %) or more at one year;
• Remission of diabetes (HbA1c <48 mmol/mol) at 1 year.

The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial

Despite improving evidence-based practice following clinical guidelines to optimise drug therapy, Type 2 diabetes (T2DM) still exerts a devastating toll from vascular complications and premature death. Biochemical remission of T2DM has been demonstrated ...

www.ncbi.nlm.nih.gov

 

[JITR]

Yes, I thought 48 mmol/mol came from DiRECT. As a clinical trial for a managed programme, I presume the bar for remission had to be set at a generally acceptable level.

However for the newly diagnosed left to their own devices, like me, the results of Counterpoint are the ones that matter. They showed we can most probably reverse our fatty livers by losing 15 kg +/- , and in doing so put T2D behind us for so long as we keep our weight down.

The target for that is below 42 mmol/mol; preferably below 39 mmol/mol which I believe is still the threshold in the USA and Germany, no doubt for good reason.

 

[Drummer]

Ando asked what remission looks like:

View attachment 31361

The graph comes from Figure 4 in Type 2 diabetes and remission: practical management guided by pathophysiology Responders are represented by solid circles. I have added the horizontal line at HbA1c 6% (42 mmol/l) to show the responders BG returned to normal levels without medication (withdrawn on day 1 of the study).

Quote: "... with beta‐cell capacity to recover being determinative for remission of type 2 diabetes."

Fortunately, a finger prick of 5.8 mmol/l on New Year's Eve 2022 showed I was a responder myself.

Thank you for the line at HbA1c of 42, as I was never sure where I was on that graph - the answer being exactly on that line for some years, and now 43 - but I am 73 years old and I started of with HbA1c of 91 so my claim to be a very ordinary type 2 seems to be a logical conclusion to draw.
I do feel rather guilty about achieving remission by a simple reduction in carbs, and no great effort.

 

[louisew]

500mg by itself doesn’t do much, the only reason for starting on such a low dose it to get used to the side effects before building up the dose

I started on 500 mg and within a couple of weeks my basal requirements had gone down to 4 units from 14 and bolus from 12 to below 6. And within a month my hbac1had gone from 6.1 to 5.8, so even this small amount made a difference to me. Now on 1000 mg and hbac1 is at 5.4