Pathway to remission

[Winifreds child]

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:

View attachment 35436


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!)

Thanks so much for this I found it very encouraging I think I have more or less decided on this type of approach I have been having a bit more protein lots of veg I did understand muscle mass due to a seven year leg injury that requires exercise every day to maintain muscle strength thanks for showing me this and I appreciate your time and to everyone who have helped I’m so grateful i shall let everyone know my progress

 

[everydayupsanddowns]

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

That’s not an opinion or stat I’ve heard before - and it certainly doesn’t seem to match with some members here who achieve remission with 100% menu adjustments and no meds at all!

Can you remember where you read it?

 

[Winifreds child]

That’s not an opinion or stat I’ve heard before - and it certainly doesn’t seem to match with some members here who achieve remission with 100% menu adjustments and no meds at all!

Can you remember where you read it?

Hi yes I read it on here last night but just had a look and can’t find it or the person who sent it it was a sort of clip of information I don’t know how to include links and stuff but it seemed very official and actually married up with something the doctor had said so I took it for gospel if I find it I’ll jot it down and let you know it was the first message I’d had from that person I remember that it made me think the doctor had been right and no such thing as remission but the today read Roy Taylor s book and sort of tried to give myself hope again

 

[medidia]

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.

Well said.

 

[Drummer]

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 .

I read this earlier and could not make sense of it, but thought it might become clearer if I left it a little while - but it seems not.
The low carb diet I changed to when diagnosed moved my readings, tests, and how I felt, from full on diabetic, and a bit dismal, back to just about normal and feeling well - there is no part way fixed but still mostly unwell about it.
The medication I was put on caused a few months of disruption, but at 6 months all was just about fine. At 18 months the last aches subsided and my memory was improving. That was the tablets though, not the diabetes.

 

[CarolT]

I’m on phase 2 of the pathway to remission programme, just re-introducing normal meals now. I think it’s worth mentioning that diet is just part of the pathway, and that exercising is really important too. Obviously that is going to look different for each individual, depending on their other health issues and their starting point, but I would absolutely encourage you to move more, particularly after eating. I have certainly found that the more I do, the more I want to do. Good luck!

 

[Eddy Edson]

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:

View attachment 35436


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!)

Gil Carvalho just posted a video on this:

He rightly notes that sustainability is really the biggest issue and there is every reason as far as I can see to expect that the gains people made in the trial will be not be sustainable for the majority, once all the support goes away - as with every lifestyle intervention.

Also, just to point out that the intervention diet in this case was 25% protein, 50% carbs, 25% fat, so yet another demonstration that low carb is not an essential part of getting to remission in most cases: basically any calorie-restricted diet will work.