Quite cheery news

[Deleted member 21371]

I doubt it. I was looking into the history of diabetes a while back, out of curiosity regarding when we adopted the terms 'Type 1' and 'Type 2'. This terminology is actually quite recent-- adopted as the norm I think in the early 1990s?

But, even before the invention of any type of testing strips (let alone the invention of the HbA1c test), it was easy to diagnose diabetes: sugar in the urine. The doctor-- or, if he was lucky enough to have a student, his student-- would taste it ...

And the difference between what we now call Type 1 and Type 2 has also always been easy to recognise. Before insulin was discovered and used as treatment, Type 1 was invariably fatal and fairly quickly-- with little or no insulin, you literally starve to death no matter how much you eat. Significant unintentional weight loss is still a key clinical diagnostic criterion for Type 1.

What we now call Type 2s were easily identifiable as those diabetics who did not suffer from unintentional weight loss but did develop the classic complications of diabetes: poor wound healing, diabetic neuropathy, diabetic retinopathy, etc.

Indeed.

Transistor asked "How did you make people walk?" Easy:

50 years ago, more people lived in environments that encouraged and facilitated walking-- to school, to shops, to work, to your local train station or tram stop-- and far fewer people had cars.

But then, for 50 years, we've had policies which have actively encouraged car use and made it much easier and more convenient than walking or cycling or taking public transport. In fact we've had policies which, for many people in many parts of the country, have made it practically impossible not to use a car.

What we need-- for the sake of people's physical and mental health, and for the sake of the environment-- is to reverse this, asap. Walking and cycling and public transport need to be made much easier and more convenient than using a car.

This is not rocket science; we've done it before, and we can do it again.

When I moved into a city a few years ago, I didn't have a car.
I have owned one briefly since, but only for a few months.
I've gotten used to being able to walk to all the places I needed to.
(Since then though, my partner does have one, but we still use public transport or our legs when we can)

 

[Eddy Edson]

When I moved into a city a few years ago, I didn't have a car.
I have owned one briefly since, but only for a few months.
I've gotten used to being able to walk to all the places I needed to.
(Since then though, my partner does have one, but we still use public transport or our legs when we can)

I don't need a car where I am either, and it's great. Most things I need within a 10 min walk, almost everything within 30 min. And a huge spread of really lovely parklands ringing the city centre to walk in.

I keep hearing horror stories from the UK of things like local councils tearing down trees and hedges and generally trying to Mordor-ise the place. Meanwhile my council is finishing off a big wetlands development in the parklands near me, right in the middle of town, as a haven for birds of all kinds. Swans have found it now, and corellas and galahs swarm there in huge flocks in the evening, quite a sight.

 

[harbottle]

It's private developers who do that! Someone bought a weird patch of land near us and stripped it without getting permission. When the council found out they put preservation orders on the trees that had survived and rejected planning permission.

The suburb I live in is surrounded on 3 sides by greenery (A park, a common, and a fragment of countryside that were there before the city expanded, now a stream, and wild fields/woodland) and there's a decent local high street, plus it's only 30 minutes to walk to the city centre (Where I will be tonight having a few drinks!). The damage inflicted on the city to accommodate cars has been immense, most of it was wrecked to build a ghastly ring road that has ruined the place (Despite warnings from planners)! And don't start me on the retail parks - soulless, dismal places.

 

[Robin]

I keep hearing horror stories from the UK of things like local councils tearing down trees and hedges and generally trying to Mordor-ise the place.

I think that’s a sign of things going the other way. Once, nobody would have batted an eyelid if the council had come along and chopped a row of trees down, whereas now, it makes headline news.
In our area, we are in a Tree conservation Area, which means we have to apply to the council every time we want to fell or even prune a tree, and they do say no, if there isn’t a good reason. And people do report illicit tree work, we had one of the neighbours straight round demanding to see our licence to fell when our tree surgeon switched on his chain saw. (we’d got permission because it was diseased and dangerous, and removing it gave more light and space to the remaining trees)

 

[Deleted member 21371]

I'm fortunate.
A good transport system, car free city centre, a good range of canels and rivers to walk, yes, there is a lot of house building, but in the city itself it's mostly restoring derelict warehouses and the like as apartments, and not every apartment will have parking spaces.
Urban housing estates are spreading though, but general population increase necessitates that.
That is turn though does have park areas planned in, shops, doctors, schools, and interestingly some apartment blocks rather than the classic British house so it's not all doom and gloom here.

 

[nonethewiser]

I doubt it. I was looking into the history of diabetes a while back, out of curiosity regarding when we adopted the terms 'Type 1' and 'Type 2'. This terminology is actually quite recent-- adopted as the norm I think in the early 1990s?

But, even before the invention of any type of testing strips (let alone the invention of the HbA1c test), it was easy to diagnose diabetes: sugar in the urine. The doctor-- or, if he was lucky enough to have a student, his student-- would taste it ...

And the difference between what we now call Type 1 and Type 2 has also always been easy to recognise. Before insulin was discovered and used as treatment, Type 1 was invariably fatal and fairly quickly-- with little or no insulin, you literally starve to death no matter how much you eat. Significant unintentional weight loss is still a key clinical diagnostic criterion for Type 1.

What we now call Type 2s were easily identifiable as those diabetics who did not suffer from unintentional weight loss but did develop the classic complications of diabetes: poor wound healing, diabetic neuropathy, diabetic retinopathy, etc.

Indeed.

Transistor asked "How did you make people walk?" Easy:

50 years ago, more people lived in environments that encouraged and facilitated walking-- to school, to shops, to work, to your local train station or tram stop-- and far fewer people had cars.

But then, for 50 years, we've had policies which have actively encouraged car use and made it much easier and more convenient than walking or cycling or taking public transport. In fact we've had policies which, for many people in many parts of the country, have made it practically impossible not to use a car.

What we need-- for the sake of people's physical and mental health, and for the sake of the environment-- is to reverse this, asap. Walking and cycling and public transport need to be made much easier and more convenient than using a car.

This is not rocket science; we've done it before, and we can do it again.

Some great points there.

Might be wrong, but not long after being diagnosed in 1981 there was somebody in hospital diabetes clinic waiting to be seen, they had foot issue & were in plaster, remember consultant at time saying that they had type 2 not Type 1 as I enquired about guy waiting.

 

[nonethewiser]

The UK has made a huge mistake by moving everything 'out of town' to such an extent that you have to drive everywhere. The city I live in certainly a 'donut city' and the post-war planning managed to make walking into the centre utterly unappealing.

Those retail parks have grown arms & legs over last 40 years, can see why companys would do this as there's not enough car parking spaces around city centres as people are to reliant on cars to get there now, plus councils charge far to much to park in city centre car parks whereas retail parks are free or free for first 3 hours.

 

[Deleted member 21371]

Some great points there.

Might be wrong, but not long after being diagnosed in 1981 there was somebody in hospital diabetes clinic waiting to be seen, they had foot issue & were in plaster, remember consultant at time saying that they had type 2 not Type 1 as I enquired about guy waiting.

It was pre world war 2 the difference was suggested.

 

[Deleted member 21371]

Those retail parks have grown arms & legs over last 40 years, can see why companys would do this as there's not enough car parking spaces around city centres as people are to reliant on cars to get there now, plus councils charge far to much to park in city centre car parks whereas retail parks are free or free for first 3 hours.

The "flat pack" era.
Buy your goods, take it away there and then.

But that has passed, internet shopping has replaced it, buy from a virtual shop, it's delivered to the room of your choice, retail parks are becoming dinosaurs.
City centres should be encouraging vehicles to stay out, Oxford has a good policy that others can follow.
Mine closed to traffic a long time ago, to the extent they don't need to look at clean air zones in the foreseeable future.

 

[nonethewiser]

The "flat pack" era.
Buy your goods, take it away there and then.

But that has passed, internet shopping has replaced it, buy from a virtual shop, it's delivered to the room of your choice, retail parks are becoming dinosaurs.

Blame MFI for start of flat pack era lol

Not all retail parks are struggling mind, lot depends on size of them plus variety of shops.

 

[Deleted member 21371]

Blame MFI for start of flat pack era lol

Not all retail parks are struggling mind, lot depends on size of them plus variety of shops.

Not all, true.
There is a critical mass they need to achieve to keep going, and it seems to be getting bigger.

When you look around them, they are starting to resemble high streets, with a lot of closed businesses and charity shops having shop fronts there now as well.
The slack from the closed shops has to be picked up by the others, ok if there is 200 or 300 open stores to pay more rent, not good if it's only 10 still open in a small park.

 

[AndBreathe]

It really looks like kind of like any other fairly-intensive intervention program at the 5 year point - not terrible, not great. Weight Watchers gets about the same kind of result,a according to their clinical trials. Virta press releases (no l/term clinical trials) also look about the same https://forum.diabetes.org.uk/board...aybe-about-as-good-as-weight-watchers.100474/

Most people will need meds to maintain the weight loss.

May I ask why you consider most people will needs medication to maintain weight loss, and what those medications might be?

Thanks.

 

[harbottle]

Those retail parks have grown arms & legs over last 40 years, can see why companys would do this as there's not enough car parking spaces around city centres as people are to reliant on cars to get there now, plus councils charge far to much to park in city centre car parks whereas retail parks are free or free for first 3 hours.

The retail parks that have been built since the late 1980s initially were just the 'big goods' retailers that were not really suitable for city centres, but over the years they've become more like high street retailers and the surrounding towns have suffered as well as the city centre.

I can't stand them. The same old stuff everywhere. Years ago the best part about visiting a town was finding all the independent stores/cafes/restaurants that existed just outside the central business district. Now centres are dying, and these horrible 'edge cities' are generally designed for a handful of large retailers, that's all going.

 

[Drummer]

I think that for many type 2s it is the uncontrolled blood glucose which causes the weight gain.
As I am, apparently 70lb down from my heaviest weight, but have never tried to lose weight since diagnosis, I don't believe that the weightloss is the reason for remission. I just took control of my eating and set fire to the GP's printouts advising low fat and high starch. Some time later my clothes were loose and baggy and my trousers fell down a couple off times. I thought it was just the elastic getting old as I could almost claim PTSD after some encounters with GPs where they went ballistic over my gaining weight on their diets.
At the age of 72 and after 5 bouts of Covid and 2 jabs (the AZ and the first one, I thought had killed me) I suspect that my body will not recover, my heartbeat is irregular for a start, and I do cough a bit - but considering that we lost our bass player from the band I'll take survival for as long as it lasts.
I am still having to remake garments or buy new ones in smaller sizes or to fit my more ) ( shape, and I am still working on the knitting machines which are heavy to move about.

 

[Dragonheart]

So actually 11 / 98 = about 11% in remission at 5 years.

As with the 2 year result, the main thing determining this would have been how successful individuals have been at maintaining weight loss. The average weight loss from base line for these 11 in-remission folks at the 5 year mark was 8.9kg, down from the ~15kg for those in remission at 2 years.

It's not bad but it's not stellar and for me it just once again demonstrates how difficult it is for many, many people to maintain weight loss, even if it means losing T2D remission. Plenty of people can - eg me, you - but basically we're lucky. Others need more help.

It’s also with ongoing support and several of those 11 needed to redo parts of the original program to get back on the wagon when they fell off.

 

[Deleted member 21371]

It’s also with ongoing support and several of those 11 needed to redo parts of the original program to get back on the wagon when they fell off.

Everything needs support.
My HCP's are an amazing bunch.
It would make no sense to cut anyone adrift.

 

[Spathiphyllum]

Some great points there.

Might be wrong, but not long after being diagnosed in 1981 there was somebody in hospital diabetes clinic waiting to be seen, they had foot issue & were in plaster, remember consultant at time saying that they had type 2 not Type 1 as I enquired about guy waiting.

If you look at medical articles from, say, 1970-2000, it seems there was a sort of overlap period, when different medics used different terminology. Some medics used 'juvenile diabetes' versus 'adult-onset diabetes'-- but of course the problem with that was that there have always been some adult-onset Type 1s. Some medics used 'insulin-dependent diabetes mellitus' ('IDDM') and 'non-insulin-dependent' ('NIDDM')-- but the problem with that was that some of what we now call Type 2s eventually become insulin dependent ...

In the 1970s it was demonstrated that what we now call Type 1 is an autoimmune disease and the other kind isn't, and the terminology of 'Type 1' and 'Type 2' started to take off. But I think-- can't find the reference now!-- this only became completely established in the 1990s, when the World Health Organisation decided the terms Type 1 and Type 2 should be used.

So your consultant in 1981 was well up-to-date, even ahead of the curve. ; )

 

[everydayupsanddowns]

Yes that was my introduction in 1991 @Spathiphyllum @nonethewiser

Maturity Onset and Juvenile Onset was old hat, and the ‘new’ terms Type 1 and Type 2 were arriving.

IDDM and NIDDM take me back too - but presumably even then they needed to change the classification if someone with ‘maturity onset’ T2 moved onto insulin?

 

[Dragonheart]

Everything needs support.
My HCP's are an amazing bunch.
It would make no sense to cut anyone adrift.

Lucky you. Agreed it makes no sense to cut people loose but that’s very common now and I don’t see a lot changing in the near future. On a population scale it’s highly unlikely they’d have the hcp’s needed to provide anything like the support these people got. Also remember by agreeing to be on the trial they are likely amongst the more motivated. Can you imagine that the wider public with less support will achieve the same 11%? I can’t unfortunately.

The trial was vitally important for two reasons though imo. The nhs accepts it has proven remission is possible, which opens a lot of doors away from a purely medicated approach. And obviously for those like you it does work for it puts them on a healthier path going forwards.

Also remember this only account for the subsection of type 2 that this approach works for. So that optimistic 11% isn’t 11% of all 4.2 million of us. I lost more than 20% (over 15kg) of my body weight, admitted not on this style program but low carb/keto (Professor Taylor is on record as having said it doesn’t matter how you lose the weight). Whilst I did achieve remission into normal not just pre diabetic levels without starving or drugs it did require me to maintain low carb eating rather than eat as “normal”. So it’s not the panacea to eat a “balanced” higher carb diet for all. Some of us have more causing our issues than just visceral or body fat. I didn’t even eat high carb in the first place as I don’t much like a lot of them and never had.

 

[Eddy Edson]

It’s also with ongoing support and several of those 11 needed to redo parts of the original program to get back on the wagon when they fell off.

Same as any other lifestyle weight-loss program. It's not a point against the NHS program. This data shows it working as well as or better than anything else.