Hi @everydayupsanddowns I'd also be interested please - I agree DUK & DiRECT are hugely important pieces of work - I wouldn't be able to participate in the NHS Pilot if it wasn't for both!
International experts outline diabetes remission diagnosis criteria – Diabetologia
diabetologia-journal.org
Summary: Defines "remission" as HbA1c < 48 mmol/mol persisting for at least 3 months in the absence of meds.
Given that this is the consensus of of the ADA, DUK, the EASD and the ES, I guess it is now the "official" definition.
People with type 2 diabetes should be considered in remission after sustaining normal blood sugar levels for three months or more, according to a new consensus statement from the Endocrine Society, the European Association for the Study of Diabetes (EASD), Diabetes UK and the American Diabetes Association, and co-published in Journal of Clinical Endocrinology & Metabolism, Diabetologia, Diabetic Medicine and Diabetes Care.
About 10% of the U.S. population has diabetes, and these numbers continue to rise. People with type 2 diabetes can achieve “remission” by sustaining normal blood sugar levels for at least three months without taking diabetes medication. There is still a lot of uncertainty around how long remission will last and what factors are associated with a relapse. A person may require ongoing support to prevent a relapse or a hyperglycemic episode, and the long-term effects of remission on mortality, heart health and quality of life are not well understood.
“Our international group of experts suggest an HbA1c (average blood sugar) level of less than 6.5% [ie 48 mmol/mol] at least three months after stopping diabetes medication as the usual diagnostic criterion for diabetes remission,” said statement author and Endocrine Society member Matthew Riddle of Oregon Health & Science University in Portland, Ore. Riddle is chair of the Diabetes Remission Consensus writing group that developed the statement. “We also made suggestions for clinicians observing patients experiencing remission and discussed further questions and unmet needs regarding predictors and outcomes.”
The authors developed the following criteria to help clinicians and researchers evaluate and study diabetes remission using more consistent terminology and methods:
“Diabetes remission may be occurring more often due to advances in treatment,” said Amy Rothberg of the University of Michigan in Ann Arbor, Mich. Rothberg represents the Endocrine Society as a member of the Diabetes Remission Consensus writing group. “More research is needed to determine the frequency, duration and effects on short- and long-term medical outcomes of remission of type 2 diabetes using available interventions.”
- Remission should be defined as a return of HbA1c to less than 6.5% [48 mmol/mol] that occurs spontaneously or following an intervention and that persists for at least three months in the absence of usual glucose-lowering pharmacotherapy.
- When HbA1c is determined to be an unreliable marker of long-term glycemic control, fasting plasma glucose of less than 126 mg/dL (<7.0 mmol/L) or estimated HbA1c less than 6.5% calculated from CGM values can be used as alternate criteria.
- Testing of HbA1c to document a remission should be performed just prior to an intervention and no sooner than three months after initiation of the intervention or withdrawal of any glucose-lowering pharmacotherapy.
- Subsequent testing to determine long-term maintenance of a remission should be done at least yearly, together with the testing routinely recommended for potential complications of diabetes.
Oh, I agree. BP, lipids, kidneys are generally way more important than BG once you get down to 48-ish (or higher) mmol/mol HbA1c levels. People stressing about whether they score sub 48 or sub 42 or whatever, where the exact number makes sod all difference for health outcomes, are not doing themselves a service if it means they're ignoring the other markers.
You can understand them not wanting to get involved in Taylor's simplistic fat shaming version of Type 2 especially as his experiment wasn't all that successful. And as Eddie Edspn keeps reminding us the benefits of the Newcastle diet's short sharp shock wash out over time as the reality of the condition, chiefly Insulin Resistance, re-assert themselves.
No, in the studies remission "washes out over time" if you stack the fat back on again, not otherwise (over the 2 year follow-up). Maintaining the weight loss is the hard thing.
Yes, the short sharp shock hasn't done anything tp address the underlying problem. Its Insulin Resistance that's causing the weight gain.
No. The model I know of which says something like that is sometimes called the "carbohydrate insulin" model and a series of experiments by Kevin Hall & others have pretty much put a fork in it, I would say. https://www.niddk.nih.gov/about-niddk/staff-directory/biography/hall-kevin/publications
Exactly...
I'm confused - the top says three months but the link says six?I was reading this Diabetes UK position statement on how the consensus was put together a couple of days ago.
There’s a more person-with-diabetes-friendly version which explains things here too 🙂
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
Perhaps you are being unnecessarily frugal in allowing only 2 types of T2. When I was dxed in 1992 it was commonplace to hear that Type 2 Diabetes was a label covering half a dozen different conditions with a common symptom. In the late 1990s we heard a lot about about Amylin, that excess amylin was the major problem for some T2s. It was seriously proposed by some authorities that up to 10-15% of T2s should be redxed as 'Amylinotics' but that would mean testing newbies for amylin levels which is never going to happen. And of course investigations have shown that between 20 and 30% of T2s have malformed insulin without the tethers needed to tether themselves to the insulin receptor port on the cell wall. That's the cause of their Insulin Resistance. Again are they going to test the insulin of every new T2 ? No way, even though that research suggests that up to 30% of T2s just need insulin injections from the get go to replace their wonky stuff.
Diabetes UK has invested too much time, money and emotional capital in Direct trial. And that inappropriate term 'remission', is seductive and beguiling newbies into believing they can return to 'normal' with a quick shake of Sooty's Magic Wand.
Quite agree @Burylancs but you have got to start somewhere. My underlying point is that the more precise the information, the better the decisions made on the basis of it. All too often more effort is spent arguing about the meaning of limited information than would be spent getting better data.
Makes a difference to me - I had an HbA1c three months after coming off metformin. So by one definition I'm in remission by the other I will have to wait for my next test
