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Pathway to remission

Winifreds child

Winifreds child

Active Member
Relationship to Diabetes
Type 2
Has anyone over the age of 68 gone on the pathway to remission without medication or is it not allowed
 
If you mean the course when I looked you had to be 65 or under with a bmi of 27 or more. Given your recent weight loss you may not be within this cohort. There is a lower bmi for some ethnicities where there is a high rate of type 2. I am aware some people in the forum have followed their own path.
 
This is from the NHS Pathway to Remission Website....

Who is eligible and how to access the service​

The NHS Type 2 Diabetes Path to Remission Programme will not be suitable for everyone and there are some eligibility requirements that people must meet to be involved. These include that individuals must:

  • be aged 18 – 65 years,
  • have a diagnosis of type 2 diabetes within the last 6 years, and
  • have a BMI over 27 kg/m2 (where individuals are from White ethnic groups) or over 25 kg/m2 (where individuals are from Black, Asian and other ethnic groups)
 
Winifreds child said:
Has anyone over the age of 68 gone on the pathway to remission without medication or is it not allowed
Click to expand...
You don't have to be on a programme to get to remission, though. I was also too old (diagnosed aged 70) but I researched what was needed and then got on with it. Going it alone takes willpower, commitment and determination and it helped that I signed up to DUK and was able to tap into the vast library of experience that this forum provides.
 
We have a number of forum members who have embarked on their own self-directed path towards remission, either through weight loss, or by following a low carb menu.

You might find some of the experiences shared here helpful:
forum.diabetes.org.uk

Community - Chat with People about Remission

forum.diabetes.org.uk forum.diabetes.org.uk

Remission isn’t possible for everyone - at any age - but there are combinations of dietary approaches and medication if necessary, that can be very effective at managing glucose levels.

Good luck with improving your diabetes management, whether that meets the definition of ‘remission’ or not 🙂
 
Martin.A said:
You don't have to be on a programme to get to remission, though. I was also too old (diagnosed aged 70) but I researched what was needed and then got on with it. Going it alone takes willpower, commitment and determination and it helped that I signed up to DUK and was able to tap into the vast library of experience that this forum provides.
Click to expand...
Hi thanks for your reply I was very interested in your story and admire that you have achieved it …did you get pressurised or was your doctor in agreement …I feel I could do it but see it’s not easy the reward being no tablets no side effects the only down side I can see is if complications do happen you have to take the blame …but life takes it’s course anyway I would accept seriously restrictions of what to eat to live my life out naturally….but I have to admit I was definitely upset by my doctor’s aggressive attitude and definitely intimidated that has happened twice now and I’m really shocked ….so I feel I have the strength to get my results but not sure if I have enough to stand up to the doctor or go against them that feels a bit pathetic my family don’t know how to advise me
 
Winifreds child said:
Thanks for the message I can see now they do have a cut off …not sure if it’s for financial reasons or we are just written off after 65 it’s a complex business this diabetes
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It’s probably more cost effective for younger people who have more likelihood of long term complications. As you get older and particularly once you’re over 65 the length of long term complications is shortening. There’s probably other things involved too like frailty etc, people tend to be on other medications for other conditions as they get older making it more complicated, etc.
 
Winifreds child said:
Hi thanks for your reply I was very interested in your story and admire that you have achieved it …did you get pressurised or was your doctor in agreement?
Click to expand...
The short answer to your question is neither. Apart from telling me I had diabetes (but not which type) my GP did nothing except hand me over to the DN, who decided I was T2 and prescribed Metformin. As is my way I left the surgery determined to learn all I could about T2 and how to manage it, and it was during my research that I came across stories about remission. Six weeks later I was making such good progress in bringing down my BG that the DN suggested I stopped taking the Metformin to see how I got on without it. I haven't taken it since. The most support and encouragement I got was from this forum, which dwarfed (and still does) anything from my surgery.
 
I haven't tried the pathway. My hba1c end of June, test at my request was 69. I rarely exercised and had put on weight after an early menopause. I had been 89 kg for years as I had the will power not to go over.but if i had seen an encouraging doctor low carb i now know would have reduced my weight. I was told my cholestral had crept up so cut pastry cakes and red and processed meat. I started walking more. I was eating lots of fish and veg, low carb without realising. I was losing 2lb a week. I was disappointed my hba1c had only reduced to 64. Two weeks later I saw the DCN she said the hcp I had seen had written SGLT2. She didn't know whether I should have metformin or the SGLT2. Neither were discussed. She said she'd phone me after speaking to hcp. Result was metformin. Once I'd reached 4 my dose was altered to 2 and SGLT2 added Two weeks later a statin was added. I liked the low carb but felt knocked off course by the SGLT2 as I was given conflicting advice about carbs. By end of September my hba1c was 51.
I wish I had discovered forum earlier and made more of an effort. I was 70 when diagnosed so couldn't join official remission programme plus in any event having started with a bmi of 32 I'm now under 27. Eg I've lost more than 2 stone.

Having seen how my surgery operates I'm sure the remission programme is not cost effective for over 65s or those overweight a little. I've had high BP since 2007 and I had hba1c in 2014 but not told. I had assumed my blood's tested each year for diabetes but it wasn't. This seems to have been a financial not clinical judgment,
Good luck in what you decide to do. Be bold.
 
Winifreds child said:
Hi thanks for your reply I was very interested in your story and admire that you have achieved it …did you get pressurised or was your doctor in agreement … but I have to admit I was definitely upset by my doctor’s aggressive attitude and definitely intimidated that has happened twice now and I’m really shocked ….so I feel I have the strength to get my results but not sure if I have enough to stand up to the doctor
Click to expand...

Sorry to hear you’ve had such e negative experience with your Dr @Winifreds child - it’s not right that you should be made to feel intimidated, and scared to advocate for your own health.

Remission is generally defined as maintaining an HbA1c below 48mmol/mol without the need for medications. So forum folks who have aimed for remission either under their own steam, or as part of an NHS provided programme are actively reducing their risk of complications. If their efforts were not maintaining the reduction in HbA1c, there would be a need to consider adding some medication or other as an additional support.

In fact I believe @Martin.A took medication initially. And only gradually reduced/removed it when his levels had improved such that it no longer seemed necessary.

I think the aim here is diabetes management rather than ‘no meds’. In some senses I think it’s slightly unfair on T2s, because some HCPs seem to treat medication (and especially adding further medications) as a mark of ‘failure’, in a way they never would for insulin with T1s. But different bodies need different support/help… and to my mind it should be improved diabetes management that you aim for.

If you can manage that with reduced meds, then that’s all well and good… but only if your BG levels are equally well managed without them. 🙂
 
A new little study: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-025-04072-4

Effect of hypoglycemic agents with weight loss effect plus a high protein diet and moderate exercise on diabetes remission in adults with obesity and type 2 diabetes: a randomized controlled trial​


Getting to remission with a more modest calorie restriction than the Pathways/DiRECT approach (~500 cal per day restriction vs cutting to 800-900 cal total); using a generally healthy diet (in this case, high protein) and moderate exercise; and continuing to take T2D meds until the end point reached.

The overall point is that you can get good results, and maybe better adherence, without the hard-core calorie restriction usde in the DIRECT approaches, and it can help if you stay on meds until you lose enough weight/visceral fat to get to remission.

Really impressive results in this study, driven mainly by great adherence to the diet:

1747613179563.png


Anyway, FWIW it's close to what I did: cutting about 500 cal per day, grinding off a half a kilo to a kilo per week, moderate exercise, staying on metformin for a while etc. Not sure how important the high-protein piece is, from an adherence point of view, but in any case keeping protein reasonably hgh is beneficial to prevent too much loss of muscle mass with extended weight loss. (Wish I had realised that at the time!)
 
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Eddy Edson said:
Anyway, FWIW it's close to what I did: cutting about 500 cal per day, grinding off a half a kilo to a kilo per week, moderate exercise, staying on metformin for a while etc. Not sure how important the high-protein piece is, from an adherence point of view, but in any case keeping protein reasonably high is beneficial to prevent too much loss of muscle mass with extended weight loss. (Wish I had realised that at the time!)
Click to expand...
Pretty much my path, too. I also followed the principle that upping protein helps to offset the loss of muscle mass as you get older, until I saw a CKD Stage 3a diagnosis pop up on my Patient Access record. Since too much protein can be bad for kidney health I eased off and went for the grams-per-kilo-of-body-weight approach instead.

However, when I saw my DN last week they said that it's unlikely I ever had Stage 3a as it isn't diagnosed on the basis of one result. I should have had a second test to confirm it. My last three eGFR results are Stage 2 (mild), which suggests my DN is right.
 
Martin.A said:
The short answer to your question is neither. Apart from telling me I had diabetes (but not which type) my GP did nothing except hand me over to the DN, who decided I was T2 and prescribed Metformin. As is my way I left the surgery determined to learn all I could about T2 and how to manage it, and it was during my research that I came across stories about remission. Six weeks later I was making such good progress in bringing down my BG that the DN suggested I stopped taking the Metformin to see how I got on without it. I haven't taken it since. The most support and encouragement I got was from this forum, which dwarfed (and still does) anything from my surgery.
Click to expand...
I think that’s amazing actually do you find your new lifestyle and diet hard to keep to do you ever eat bread
 
Winifreds child said:
I think that’s amazing actually do you find your new lifestyle and diet hard to keep to do you ever eat bread
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Yes, I do eat bread but not every day and rarely more than one slice (as toast). I avoid the mass-produced stuff that supermarkets sell, though. We buy unsliced seeded wholemeal from the shop at our local garden centre. It comes in fresh every day from a bakery just over the border in Hampshire.

I've had no problem sticking with my new lifestyle and diet so far. It's become a way of life.
 
Another who cut out a few things and changed a few things to get my blood glucose back under control. I doubt anybody actually noticed the changes I made. Where I differ a little is that I am happy with an HbA1c of around 48 as it is now and would not be unduly concerned if it went up to the mid 50's as it is likely to do as I get older and older. What I might gain from reducing my HbA1c - a tiny, tiny decrease in the risk of developing complications in an ever shortening future - is not worth the hassle of trying to do it.
 
saffron15 said:
I haven't tried the pathway. My hba1c end of June, test at my request was 69. I rarely exercised and had put on weight after an early menopause. I had been 89 kg for years as I had the will power not to go over.but if i had seen an encouraging doctor low carb i now know would have reduced my weight. I was told my cholestral had crept up so cut pastry cakes and red and processed meat. I started walking more. I was eating lots of fish and veg, low carb without realising. I was losing 2lb a week. I was disappointed my hba1c had only reduced to 64. Two weeks later I saw the DCN she said the hcp I had seen had written SGLT2. She didn't know whether I should have metformin or the SGLT2. Neither were discussed. She said she'd phone me after speaking to hcp. Result was metformin. Once I'd reached 4 my dose was altered to 2 and SGLT2 added Two weeks later a statin was added. I liked the low carb but felt knocked off course by the SGLT2 as I was given conflicting advice about carbs. By end of September my hba1c was 51.
I wish I had discovered forum earlier and made more of an effort. I was 70 when diagnosed so couldn't join official remission programme plus in any event having started with a bmi of 32 I'm now under 27. Eg I've lost more than 2 stone.

Having seen how my surgery operates I'm sure the remission programme is not cost effective for over 65s or those overweight a little. I've had high BP since 2007 and I had hba1c in 2014 but not told. I had assumed my blood's tested each year for diabetes but it wasn't. This seems to have been a financial not clinical judgment,
Good luck in what you decide to do. Be bold.
Click to expand...
Thank you for your message it was interesting to me reading your story I can see small points where you might have had a bit more help or advice and that must have been disappointing but sometimes you don’t see another way when you don’t have all the information …you are making good progress that’s really good news I hope you continue to keep as well as possible …im seeing a bit of a pattern that older people seem a bit overlooked as if we don’t matter that much the numbers don’t add up to invest time or money …I didn’t get any advice in prediabetis except one nurse said don’t eat Yorkshire puddings or cheese I regret just cutting out sugar and not researching it more but can’t go back I will update my progress in the next few weeks again thankyou I appreciate your thoughts
 
everydayupsanddowns said:
Sorry to hear you’ve had such e negative experience with your Dr @Winifreds child - it’s not right that you should be made to feel intimidated, and scared to advocate for your own health.

Remission is generally defined as maintaining an HbA1c below 48mmol/mol without the need for medications. So forum folks who have aimed for remission either under their own steam, or as part of an NHS provided programme are actively reducing their risk of complications. If their efforts were not maintaining the reduction in HbA1c, there would be a need to consider adding some medication or other as an additional support.

In fact I believe @Martin.A took medication initially. And only gradually reduced/removed it when his levels had improved such that it no longer seemed necessary.

I think the aim here is diabetes management rather than ‘no meds’. In some senses I think it’s slightly unfair on T2s, because some HCPs seem to treat medication (and especially adding further medications) as a mark of ‘failure’, in a way they never would for insulin with T1s. But different bodies need different support/help… and to my mind it should be improved diabetes management that you aim for.

If you can manage that with reduced meds, then that’s all well and good… but only if your BG levels are equally well managed without them. 🙂
Click to expand...
Thanks so much for your message I appreciate your thoughts I think I am going to have this medication initially and at the same time restrict my diet to low carb continue to try to lose more weight until I reach the numbers that I think should mean I don’t need medication…just a bit worried about something I read that explains that diet can only ever help 22% of the diabetes and that leaves 78% of it going untreated in the body not finding that easy to understand or if I have that right if so does it mean diet alone could never control it do you know anything about it .
 
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