Int'l consensus statement on definition of T2D "remission"

[everydayupsanddowns]

Whilst most of those diagnosed with T2 will be carrying some additional weight, that doesn't cover everyone. My concern with the Diabetes UK statement on remission is its focus on weight loss:

"How can you put diabetes into remission?
The strongest evidence we have suggests that diabetes is mainly put into remission by weight loss. ...."

Surely T2 is put into remission by reducing the blood glucose scores? Dietary changes, resulting in weight loss may be a mechanism for doing that, but the fact there are slim and even skinny T2s suggests there's more to diabetes than love handles.

I’ve asked Diabetes UK for some feedback on your questions @AndBreathe

Diabetes UK understands that not everyone with T2 is overweight or living with obesity, but for those who are, research over the years has shown that weight loss is the primary goal to managing blood glucose levels and reducing the risk of diabetes complications​

​

The position statement is based on published research, and research to date shows that remission of type 2 diabetes occurs in people living with obesity, or who are overweight, when they lose weight. We do not currently have research to show how type 2 diabetes remission can occur in people without weight loss which is why the statement emphasises on weight loss to reflect the research evidence.​

​

There is research underway to see if the same concept of remission by weight loss can help people with type 2 diabetes with lower BMI. This would involve people aren’t usually advised by their doctors to lose weight https://www.diabetes.org.uk/research/our-research-projects/northern-and-yorkshire/retuneing-type-2-diabetes-remission. Until more research results are available, Diabetes UK can only rely on the published research which shows that type 2 remission is mainly achieved through weight loss in people who have obesity or overweight​

Interestingly the idea of achieving remission with a low carb approach that @Eddy Edson shared includes some similar language:

• Based on evidence from clinical trials, maintenance of weight loss appears to be the main driver of continued remission, and this therefore needs to be a key focus of the planning and delivery of all services designed to achieve remission.
If a diet low in carbohydrate is sustainable to the individual, normoglycaemia may be maintained in the absence of weight loss, although evidence is limited and loss of remission is likely to occur if carbohydrate restriction ceases.
• Total dietary replacements (TDR) and low carbohydrate diets have been demonstrated as being effective in facilitating weight loss and remission of T2DM. Evidence of effectiveness beyond 2 years is limited. The dietary approach should be one which the individual can maintain for the long term.

(emphasis added)

 

[Burylancs]

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

The goalposts keep moving. The original Lancet article about this in 2017 says 2 months ....
'Co-primary
outcomes were weight loss of 15 kg or more, and remission of diabetes, defined as glycated haemoglobin (HbA1c) of
less than 6·5% (<48 mmol/mol) after at least 2 months off all antidiabetic medications.'

 

[AndBreathe]

I’ve asked Diabetes UK for some feedback on your questions @AndBreathe

Diabetes UK understands that not everyone with T2 is overweight or living with obesity, but for those who are, research over the years has shown that weight loss is the primary goal to managing blood glucose levels and reducing the risk of diabetes complications​

​

The position statement is based on published research, and research to date shows that remission of type 2 diabetes occurs in people living with obesity, or who are overweight, when they lose weight. We do not currently have research to show how type 2 diabetes remission can occur in people without weight loss which is why the statement emphasises on weight loss to reflect the research evidence.​

​

There is research underway to see if the same concept of remission by weight loss can help people with type 2 diabetes with lower BMI. This would involve people aren’t usually advised by their doctors to lose weight https://www.diabetes.org.uk/research/our-research-projects/northern-and-yorkshire/retuneing-type-2-diabetes-remission. Until more research results are available, Diabetes UK can only rely on the published research which shows that type 2 remission is mainly achieved through weight loss in people who have obesity or overweight​

Interestingly the idea of achieving remission with a low carb approach that @Eddy Edson shared includes some similar language:

• Based on evidence from clinical trials, maintenance of weight loss appears to be the main driver of continued remission, and this therefore needs to be a key focus of the planning and delivery of all services designed to achieve remission.
If a diet low in carbohydrate is sustainable to the individual, normoglycaemia may be maintained in the absence of weight loss, although evidence is limited and loss of remission is likely to occur if carbohydrate restriction ceases.
• Total dietary replacements (TDR) and low carbohydrate diets have been demonstrated as being effective in facilitating weight loss and remission of T2DM. Evidence of effectiveness beyond 2 years is limited. The dietary approach should be one which the individual can maintain for the long term.

(emphasis added)

Thanks for asking for me. I appreciate it.