Quite cheery news

[Dragonheart]

If this is a first line treatment, then it is likely those receiving prescriptions will be paying for them (unless exempt by age or other conditions). Prescription exemptions are only for those being prescribed medications for diabetes.

Usually I’d have agreed but I have read that it is intended to be free. I presume they are classing this as something other than diet controlled as it’s not “real food” based in a way that most people recognise. They don’t put food on prescription whereas this will be, so I guess the issuing of the prescription is what qualifies it for free. We’ll see what actually happens as it get rolled out.

I wonder how many type 2 previously without an exemption certificate relying on diet alone will now be issued one for these shakes. There will be a fair few above 48 but below the mid 50’s where drugs are usually introduced that will fall into that area.

 

[Deleted member 21371]

Usually I’d have agreed but I have read that it is intended to be free. I presume they are classing this as something other than diet controlled as it’s not “real food” based in a way that most people recognise. They don’t put food on prescription whereas this will be, so I guess the issuing of the prescription is what qualifies it for free. We’ll see what actually happens as it get rolled out.

I wonder how many type 2 previously without an exemption certificate relying on diet alone will now be issued one for these shakes. There will be a fair few above 48 but below the mid 50’s where drugs are usually introduced that will fall into that area.

Anyone that has had an HbA1c measurement taken within the last 12 months and the results were 48-87 mmol/mol if not on diabetes medication, and fits the criteria apparently.
Obviously it's not diet control, by the fact the target isn't lifelong control of the symptoms, it's an intervention to hopefully reverse the condition causing the symptoms.

 

[Eddy Edson]

weight loss achieved by any (safe) method should be endorsed

I'm sure Taylor at any rate would agree with that in principle.

The issue from a health system POV is that only the DiRECT protocol has RCT-level evidence for remission.

Virta, Unwin don't have this for low carb. Same for low fat, vegan, Mediterranean etc etc as far as I know.

There is no high-quality evidence for wide-scale remission in the absence of weight loss.

All lifestyle interventions, including low carb, are generally as crappy as each other for maintaining weight loss beyond 12 months. Some people respond well, most don't.

So conceptually maybe it would make sense to support a broad array of maintenance strategies - low carb, Med, whatever - in the hope of increasing the chances of each individual finding something that works.

But I have no idea how you would do that in a way which avoids lots of people bouncing from one approach to another & never finding anything which does work. Which is what happens now.

(Unless you believe in a magic eat-what-you-want diet which works for most or all.)

I come back to my belief that meds have to be an essential part of the program. GLP-1RA's now, tirpezatide soon, many others hopefully cheaper & better in the pipeline.

 

[nonethewiser]

Not sure, but I started as part of the initial 5000 Pilot - I presume I'm tracked (or at least part of the figures?!)

I'm 2 years in, still in Remission, and look forward to the next 3 years, to see if I'm still there (I WILL be!)

Hope you are still there in 3 years time, well done on achievement so far.

Although not by ND but still by weight loss over short period of time my wife is still maintaing a normal Hba1c 5 years later, my guess is it was more to do with losing visceral fat around her organs that was key to remission as she eats a fairly normal diet but does monitor her weight & has regular checks ups, last Hba1c few weeks back was 34.

 

[Eddy Edson]

Although not by ND but still by weight loss over short period of time my wife is still maintaing a normal Hba1c 5 years later, my guess is it was more to do with losing visceral fat around her organs that was key to remission as she eats a fairly normal diet but does monitor her weight & has regular checks ups, last Hba1c few weeks back was 34.

Pretty much like me - maybe we're related!

 

[nonethewiser]

Pretty much like me - maybe we're related!

Possibly Eddy, comes from family of notorious criminals going back long way so some could have been deported to Australia.

 

[Dragonheart]

The issue from a health system POV is that only the DiRECT protocol has RCT-level evidence for remission.

actually not. The low carb program is accepted by some ccg/icb too. This will be the first nhs wide protocol though.

All lifestyle interventions, including low carb, are generally as crappy as each other for maintaining weight loss beyond 12 months. Some people respond well, most don't.

This shake diet is no different though really looking at the numbers.

So conceptually maybe it would make sense to support a broad array of maintenance strategies - low carb, Med, whatever - in the hope of increasing the chances of each individual finding something that works.

Exactly

 

[Dragonheart]

Hope you are still there in 3 years time, well done on achievement so far.

Although not by ND but still by weight loss over short period of time my wife is still maintaing a normal Hba1c 5 years later, my guess is it was more to do with losing visceral fat around her organs that was key to remission as she eats a fairly normal diet but does monitor her weight & has regular checks ups, last Hba1c few weeks back was 34.

Sadly not me. I lost the weight and more in the months after diagnosis despite not being obese to begin with nor having had a high sugar/carb/calorie diet, maintained it for years but still can’t deal with carbs “normally”. I got into normal levels but not the 30’s and it needs close to keto to keep me even below the 48 of remission and the weight off.

I strongly suspect those in the group like your wife, @Eddy Edson and @travellor have a different origin of their T2 diabetes than people like me (and I’ve spoken with many others like me). It’s a big bucket to assume we all got there the same way (and can get out of it the same way). More like anyone that isn’t quickly and readily identified as type 1/LADA , 3c or MODY

It’s probably why only half the people on the shake diet ever achieved remission and even fewer maintain it. It’s also why we need more than one approach to treatment. And better testing of all diabetics to establish actual insulin production. Maybe some of us simply don’t/can’t produce much and combined with other factors are always at a disadvantage compared to those that have solely lifestyle induced insulin resistance more readily “fixable” by changing those issues with weight loss, shakes or low carb alone

 

[Eddy Edson]

actually not. The low carb program is accepted by some ccg/icb too. This will be the first nhs wide protocol though.

WHat RCT's are there supporting low carb for remission? I don't know of any.

 

[bulkbiker]

for wide-scale remission

DiRECT doesn't have any evidence for wide scale remission either.
46% after 1 year
35% after 2 years
11% after 5 years.

They really aren't stellar results especially when many of those 'in remission" could still have been pre diabetic by the admission of the DiRECT scientists themselves.

 

[Dragonheart]

WHat RCT's are there supporting low carb for remission? I don't know of any.

it is a protocol for remission accepted by the nhs was my meaning.

I can’t see the actual results (remission or not) behind the paywall but this was an rct of low carb showing significant reduction of hba1c and improved glycemic control. https://pubmed.ncbi.nlm.nih.gov/34984805/

 

[bulkbiker]

WHat RCT's are there supporting low carb for remission? I don't know of any.

As we all know DiRECT wasn't randomised either...the patients all knew if they were being starved or not..

 

[Spathiphyllum]

Sadly not me. I lost the weight and more in the months after diagnosis despite not being obese to begin with nor having had a high sugar/carb/calorie diet, maintained it for years but still can’t deal with carbs “normally”. I got into normal levels but not the 30’s and it needs close to keto to keep me even below the 48 of remission and the weight off.

I strongly suspect those in the group like your wife, @Eddy Edson and @travellor have a different origin of their T2 diabetes than people like me (and I’ve spoken with many others like me). It’s a big bucket to assume we all got there the same way (and can get out of it the same way). More like anyone that isn’t quickly and readily identified as type 1/LADA , 3c or MODY

It’s probably why only half the people on the shake diet ever achieved remission and even fewer maintain it. It’s also why we need more than one approach to treatment. And better testing of all diabetics to establish actual insulin production. Maybe some of us simply don’t/can’t produce much and combined with other factors are always at a disadvantage compared to those that have solely lifestyle induced insulin resistance more readily “fixable” by changing those issues with weight loss, shakes or low carb alone

Agree that there should be more "testing of diabetics to establish actual insulin production", to avoid misclassification of T1s as T2s. And not only when people initially become diabetic, but also if their 'clinical presentation' changes.

As I've said in another post: it seems the problem is that C-peptide tests used to be very expensive and difficult, they aren't anymore, but a lot of medics don't seem to have realised this yet.

But-- if, for you, "it needs close to keto to keep ... the weight off"-- that proves definitively that your body is producing enough insulin. If your body was not producing enough insulin, i.e. if you were T1, your weight would drop like a stone (if you'll pardon the pun), no matter what you ate, and in particular no matter how many carbs you ate.

The likeliest explanation is that, even if you're now relatively slim overall, you still have enough visceral fat that you're still T2. In principle, there is an easy and definitive way to find out-- by doing an MRI scan of your abdomen. Unfortunately, MRI scans are still very expensive!

Alternatively, you could actually try a VLCD-- the Newcastle Diet or the NHS programme-- as these have been proven to give you the best chance of losing visceral fat.

 

[Eddy Edson]

it is a protocol for remission accepted by the nhs was my meaning.

I can’t see the actual results (remission or not) behind the paywall but this was an rct of low carb showing significant reduction of hba1c and improved glycemic control. https://pubmed.ncbi.nlm.nih.gov/34984805/

Thanks, looks interesting ... but frikkn paywalls

Participants remained on whatever non-insulin antidiabetic meds they normally take, and anyway the 7-ish - 8-ish mmol/mol HbA1c reduction probably not enough for significant remission rate, I guess. There was also some weight & waist reduction vs the control group, maybe hard to disentangle those as confounders.

 

[nonethewiser]

Sadly not me. I lost the weight and more in the months after diagnosis despite not being obese to begin with nor having had a high sugar/carb/calorie diet, maintained it for years but still can’t deal with carbs “normally”. I got into normal levels but not the 30’s and it needs close to keto to keep me even below the 48 of remission and the weight off.

I strongly suspect those in the group like your wife, @Eddy Edson and @travellor have a different origin of their T2 diabetes than people like me (and I’ve spoken with many others like me). It’s a big bucket to assume we all got there the same way (and can get out of it the same way). More like anyone that isn’t quickly and readily identified as type 1/LADA , 3c or MODY

It’s probably why only half the people on the shake diet ever achieved remission and even fewer maintain it. It’s also why we need more than one approach to treatment. And better testing of all diabetics to establish actual insulin production. Maybe some of us simply don’t/can’t produce much and combined with other factors are always at a disadvantage compared to those that have solely lifestyle induced insulin resistance more readily “fixable” by changing those issues with weight loss, shakes or low carb alone

No specialist on this subject but wonder if going very low carb to achieve weight loss is why you & others are so sensitive to carbs years later, whereas people like my wife & others who achieve weight loss by other methods are less sensitive to carbs.

Obviously way wife did it meant reduction in fat, chicken & tuna over red meats & some carbs she didn't exclude carbs as she still ate pasta in tuna & salad dishes rice with veg for example, plus diet allowed for 1 slice of bread daily also small portion of cereals like granola, so it was calorie reduction tion diet rather than anything else.

Maybe way of mark but trying to reason why there's a difference.

On subject of choices for those newly diagnosed type 2 & prediabetic, yes they should be choices as no one size suits all.

 

[Eddy Edson]

it is a protocol for remission accepted by the nhs was my meaning.

I can’t see the actual results (remission or not) behind the paywall but this was an rct of low carb showing significant reduction of hba1c and improved glycemic control. https://pubmed.ncbi.nlm.nih.gov/34984805/

Here's a late draft of the paper: https://findresearcher.sdu.dk/ws/files/199865152/dom.14633.pdf

 

[harbottle]

But-- if, for you, "it needs close to keto to keep ... the weight off"-- that proves definitively that your body is producing enough insulin. If your body was not producing enough insulin, i.e. if you were T1, your weight would drop like a stone (if you'll pardon the pun), no matter what you ate, and in particular no matter how many carbs you ate.

Enough insulin for what?
Enough to handle the basal glucose from the liver, but maybe not enough to handle a high carb meal and/or insulin resistance.

 

[AndBreathe]

Usually I’d have agreed but I have read that it is intended to be free. I presume they are classing this as something other than diet controlled as it’s not “real food” based in a way that most people recognise. They don’t put food on prescription whereas this will be, so I guess the issuing of the prescription is what qualifies it for free. We’ll see what actually happens as it get rolled out.

I wonder how many type 2 previously without an exemption certificate relying on diet alone will now be issued one for these shakes. There will be a fair few above 48 but below the mid 50’s where drugs are usually introduced that will fall into that area.

To be fair, diagnosed coeliacs can have a certain amount of GF food on prescription. I can recall a lady in my local pharmacy having a near melt-down because the pharmacist didn't have her loaves in for her to collect.

(Obviously we have no idea what else might have been going on in her life to lead to the drama.)

 

[AndBreathe]

Anyone that has had an HbA1c measurement taken within the last 12 months and the results were 48-87 mmol/mol if not on diabetes medication, and fits the criteria apparently.
Obviously it's not diet control, by the fact the target isn't lifelong control of the symptoms, it's an intervention to hopefully reverse the condition causing the symptoms.

You don't seem keen on the term remission, even though that is the terminology used by both Professor Taylor and Diabetes UK relating to this trial.

This is a quote from , in the article tagged in your original post:

".... New findings from a three-year extension of our landmark DIRECT study show that nearly a quarter (23%) of participants who were in remission from type 2 diabetes at two years in the original trial remained in remission at five years.

This means they no longer needed to use diabetes medications to manage their blood sugar levels...."

It doesn't say anywhere they can expect to go back to a diet fulled by Ginsters (or whatever).

 

[Burylancs]

DiRECT doesn't have any evidence for wide scale remission either.
46% after 1 year
35% after 2 years
11% after 5 years.

They really aren't stellar results especially when many of those 'in remission" could still have been pre diabetic by the admission of the DiRECT scientists themselves.

Yup, DiRECT really is 'Bad Science' as defined by Ben Godacre in his famous book of the same name. Taylor only reports on the fragments of evidence that seem to support his pet theory, classic Bad Science. All we hear about is the 11% when the other 89% did the crash diet as well ( of course they couldn't have actually followed Taylor's mathematically impossible diet involving getting up to 20% of their nutrition from Fresh Air). How are that 89% doing now ? They haven't achieved this so called 'remission' on Taylor's definition but what proportion of them have got Good C ontrol after the crash diet by continuing with other means such as medication or low carbing over the last five years? We'll never know because Taylor isn't interested in the objective truth of how best to manage T2 just in trying to prove the bee in his bonnet. And don't ask about the Control Group in the DiRECT trial, no factually accurate report has ever been made on them at 1, 2 or 5 years. They could be doing far better on the whole than Taylor's measly 11% for all anyone knows.