Once a Diabetic, always a Diabetic?

[AndBreathe]

This is great! But I'm not sure what it has to do with this particular thread.

The OP asked a very specific question. It's actually a very important discussion to have, so that perhaps we can get closer to the truth of the situation. Telling people there are far more important things to do, and how we should just live our lives, is all well and good. But it's not any reason to stop discussing specific issues.

I didn't suggest ANY discussion should be stopped, but in some way I am appealing for some balanced thinking. SOmetimes we see those willing to stop living their lives, in terms of social life or whatever, to achieve some non-assured holy grail, called remission.

In terms of the specifics? Here we go:

Q: "If people do achieve "remission" and are able to lose weight, control their diet and come off Diabetic meds, are they still considered to be a Diabetic?"
A: In my case, I have stated that my GP marked my condition as resolved. Make of that what you will.

"Thinking more about medical peeps really, GP, Diabetic nurse, etc, do you remain on their books as a Diabetic and still get the feet, eye checks, etc?
A: I addressed that I think, stating I still have annual bloods and eye checks bloods

Q: "I assume there is no "cut off" time, when you are assumed to have beaten it.
A: OK, I probably didn't overtly clear this one, but in UK there is no time frame or pathway towards "cure" or whatever. In USA, there is a timeframe, after which time, an individual is considered to have achieved "Operational Cure".

Q: "I would imagine that you are always still at risk of getting Diabetic symptoms at some point, so still need to be monitored.
A: Any sensible person would want to keep an eye on things after a T2 diagnosis.

 

[pjgtech]

I didn't suggest ANY discussion should be stopped, but in some way I am appealing for some balanced thinking. SOmetimes we see those willing to stop living their lives, in terms of social life or whatever, to achieve some non-assured holy grail, called remission.

In terms of the specifics? Here we go:

Q: "If people do achieve "remission" and are able to lose weight, control their diet and come off Diabetic meds, are they still considered to be a Diabetic?"
A: In my case, I have stated that my GP marked my condition as resolved. Make of that what you will.

Hmm, if its "resolved" then why would you need ongoing eye/bloods checking?
Personally I think its like Cancer, you can be in remission, and pretty much be living a "normal" life, but you are also always still at risk of it re-occurring. Hence the need to keep having the checks.
Just my 2c worth.

 

[harbottle]

I didn't suggest ANY discussion should be stopped, but in some way I am appealing for some balanced thinking. SOmetimes we see those willing to stop living their lives, in terms of social life or whatever, to achieve some non-assured holy grail, called remission.

In terms of the specifics? Here we go:

Q: "If people do achieve "remission" and are able to lose weight, control their diet and come off Diabetic meds, are they still considered to be a Diabetic?"
A: In my case, I have stated that my GP marked my condition as resolved. Make of that what you will.

Your GP has made made a mistake if you've been coded as 'resolved'.

 

[Martin.A]

Your GP has made made a mistake if you've been coded as 'resolved'.

Diabetes Resolved appears to be just an alternative name for Remission (Source: gpnotebook.com)

 

[harbottle]

No it isn't. They are separate clinical codes.

Resolved is for misdiagnosis and things like steroid induced diabetes (IE diabetes that goes away when the thing that causes it is removed).

Remission is the code for people who obtain normal levels with weight loss, dietary or surgical interventions. In fact, if the clinician tries to use the code 'resolved' they get a warning to ask them to consider remission instead in order to continue with the checks and eye tests:

https://www.directclinicaltrial.org.uk/Pubfiles/Beating%20Diabetes%20McCombie%202017%20bmj.j4030.full.pdf

The Read code dictionary includes codes 21263 or 212H for“diabetes resolved” and C10P for “diabetes in remission.”Diabetes resolved is used for patients misdiagnosed with diabetes or in whom diabetes was secondary to a factor that has since been removed, such as withdrawal of steroid treatment.Such patients do not require annual reviews or surveillance.Code C10P should be used for patients who have achievedremission of type 2 diabetes, usually by substantial weight loss.These patients may be considered non-diabetic for matters such as insurance, driving, or employment but as the code isdiagnostic they will remain scheduled for annual reviews and retinal screening programmes

 

[AndBreathe]

Fight amongst yourselves.

I don’t care what the label says. Labels are unhelpful, and right now, today, I can’t see it makes a difference to my life.

 

[harbottle]

It's not a label, it's a clinical code and there are two for very specific reasons and the professionals should be using them correctly.

I'd rather have the other one as I don't like being harassed every year to give samples of pee and have my feet tickled.🙂

 

[pjgtech]

Fight amongst yourselves.

I don’t care what the label says. Labels are unhelpful, and right now, today, I can’t see it makes a difference to my life.

Erm, no-ones fighting. Its called a debate or discussion.....

 

[CliffH]

Not necessarily so - the ending 'ize' has been in use in UK English for centuries. Both 'ise' and 'ize' are considered correct for many words. Colin Dexter in the plot of a Morse mystery decided a murderer was lying about his education at Harrow because he used 'ise'.

You might find it interesting to look up use of 'ize' and 'ise'.

It's lucky that I don't work in a cafe: whenever a customer asked me, "Can I get a ...", I'd have to reply, "No, you can have a ... and I'll get it for you".

 

[harbottle]

It's lucky that I don't work in a cafe: whenever a customer asked me, "Can I get a ...", I'd have to reply, "No, you can have a ... and I'll get it for you".

I would invite them round to make it themselves. And then charge them.

 

[silentsquirrel]

It's lucky that I don't work in a cafe: whenever a customer asked me, "Can I get a ...", I'd have to reply, "No, you can have a ... and I'll get it for you".

Absolutely! So irritating when contestants on Countdown ask "Can I get a vowel?" I mutter grumpily "No, Rachel will get it for you."

 

[AndBreathe]

It's not a label, it's a clinical code and there are two for very specific reasons and the professionals should be using them correctly.

I'd rather have the other one as I don't like being harassed every year to give samples of pee and have my feet tickled.🙂

I'm not required to give a pee sample (unless I think I have a UTI) and have never had my feet checked, so you'd be fine (at the surgery we have recently left).

 

[beating_my_betes]

I didn't suggest ANY discussion should be stopped, but in some way I am appealing for some balanced thinking. SOmetimes we see those willing to stop living their lives, in terms of social life or whatever, to achieve some non-assured holy grail, called remission.

Nobody is suggesting anybody stop living their lives to achieve anything. And thinking, balanced or not, is not the issue.
Someone asked a direct objective question, which deserves an objective answer. Despite many believing there is one, we've yet to find concrete evidence either way.

Nobody's forcing you to join in 😉

 

[beating_my_betes]

It's been cut and pasted from the WHO's website. The 2019 definition of diabetes. So it's straight from the horse's mouth. The z in characterized should tell us it's been written in American English.

Didn't notice the "Z", which is something I'd normally pick up on. In any case, not sure why I'd assume Martin was from the UK (Yes, I've since discovered how to find out). I was too confused by the definition. Good that they've changed it.

 

[beating_my_betes]

Of course it isn't - it's that of no less an authority than the World Health Organisation.

Very happy to see some here regard the WHO as some sort of authority. It's not common in these parts.

 

[Burylancs]

Very happy to see some here regard the WHO as some sort of authority. It's not common in these parts.

Well it's the body that decided that you had something to be known henceforth as 'Type 2 Diabetes' instead of Maturity Onset Diabetes or NIDDM ( Non-Insulin Dependent Diabetes Mellitus ) in about 1985. Yes, 'Type 2 Diabetes' is only about 40 years old ! And haven't we suffered cos of that Number 2 dumped on us.
Bring back ye 'P#ssing Evil' of ye 17th century.

 

[beating_my_betes]

Well it's the body that decided that you had something to be known henceforth as 'Type 2 Diabetes' instead of Maturity Onset Diabetes or NIDDM ( Non-Insulin Dependent Diabetes Mellitus ) in about 1985.

They aslo have good information about diet.

 

[AndBreathe]

Nobody is suggesting anybody stop living their lives to achieve anything. And thinking, balanced or not, is not the issue.
Someone asked a direct objective question, which deserves an objective answer. Despite many believing there is one, we've yet to find concrete evidence either way.

Nobody's forcing you to join in 😉

In medicine, little is concrete, unless the patient is dead, which doesn't usually take too long to determine.

 

[Dragonheart]

This paper is from the study mentioned, but isn't public.

https://www.acpjournals.org/doi/10.7326/0003-4819-124-1_Part_2-199601011-00011

This appears to only look at patients who haven't achieved normal levels, though, after dietary changes, so it'll exclude people like myself who achieved normal levels with weight loss/diet.

I've seen a few other papers from the same study on the effects of metformin, but they seem to only consider overweight patients.

This paper fails to say what mostly dietary control means. What diet? What does mostly mean?

All the papers I’ve seen comparing outcomes and making the assumptions that type 2 is always progressive seem to do similar or have all medicated patients thus actually showing all “medicated control” merely slows medication increases and likelihood of complications, ie it might give you better hba1c’s but doesn’t altogether stop the problems.

My question is why not? Could it be about hyperinsulemia and insulin resistance still happening whilst the medication mops up afterwards? Ie dealing with symptoms not cause/refilling the bucket without fixing the hole? Insufficient study, time and motivation about the long term effects of that newer approach trying to fix the insulin issues means we can’t be sure but it certainly seems feasible it might give better long term result. Given that we have been shown medicated control (as measured by hba1c) is merely an imperfect brake many of us choose to apply both that (of good hba1c) AND go for the underlying issues around insulin hoping that a dual approach as it were works out better. As more of us do this and it becomes more mainstream hopefully the evidence to turn the status quo tanker will expand. The same might be asked about theories about maintaining personal fat ratios in the organs (which potentially might boil down to insulin control too???)

 

[Dragonheart]

This paper fails to say what mostly dietary control means. What diet? What does mostly mean?

All the papers I’ve seen comparing outcomes and making the assumptions that type 2 is always progressive seem to do similar or have all medicated patients thus actually showing all “medicated control” merely slows medication increases and likelihood of complications, ie it might give you better hba1c’s but doesn’t altogether stop the problems.

My question is why not? Could it be about hyperinsulemia and insulin resistance still happening whilst the medication mops up afterwards? Ie dealing with symptoms not cause/refilling the bucket without fixing the hole? Insufficient study, time and motivation about the long term effects of that newer approach trying to fix the insulin issues means we can’t be sure but it certainly seems feasible it might give better long term result. Given that we have been shown medicated control (as measured by hba1c) is merely an imperfect brake many of us choose to apply both that (of good hba1c) AND go for the underlying issues around insulin hoping that a dual approach as it were works out better. As more of us do this and it becomes more mainstream hopefully the evidence to turn the status quo tanker will expand. The same might be asked about theories about maintaining personal fat ratios in the organs (which potentially might boil down to insulin control too???)

This paper https://www.directclinicaltrial.org.uk/Pubfiles/Beating Diabetes McCombie 2017 bmj.j4030.full.pdf

seems to be exploring the points I raise pointing out no studies on long term remission had been done at that time and

“In keeping with trends in most medical specialties, diabetes management is beginning to focus on reversible underlying disease mechanisms rather than treating symptoms and subsequent multisystem pathological consequences.3 4 Both (epi)genetic predisposition and ageing have a role in type 2 diabetes, but it is rare without weight gain.
Lowering blood glucose or HbA1c concentrations remains the primary aim of management, as reflected in current clinical guidelines and the actions of licensed drugs. However, management and guidelines focus on use of antidiabetes drugs, with only lip service paid to diet and lifestyle advice.”