Quite cheery news

[everydayupsanddowns]

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There was no "randomisation" of the support levels given to the participants though was there?
A surgery using the starvation method would have given huge encouragement to the trial participants where the "control groups" would have been left with the usual non-interference of standard care that we have all experienced because that was the point of the trial.
It's even outlined in the trial design.

I’ve not read the protocols, but that be important when evaluating something against ‘standard care’ though wouldn’t it? Otherwise you aren’t evaluating against standard care. You are evaluating against something else.

Ensuring consistency of delivery of the intervention that each participant experiences (as far as possible) between arms and across the different sites. But defining what each arm ‘means’, the levels of support, number of appointments, time spent, resources used, data collected etc.

I was involved as PPI lead on an RCT looking into T1 hypo awareness restoration, and significant trouble was taken in the protocols and study design to make sure the two different interventions being compared involved the same amount or level of input in each arm. But that wouldn’t work when comparing against ‘standard care’ as defined in current guidelines. For that you need to follow standard care, against the intervention.

 

[Eddy Edson]

As said earlier not my field so its just a theory based on observations on this forum, whereby those who go very low carb seem to react badly to any carbs whereas those who don't low carb or are less strict low carbers seem to tolerate them easier when going above their daily average.

Certainly more to it than anyone knows, our bodies are complex things.

So physiological adaption to low carb diet => temporary impaired glucose tolerance has been recognised since the olden days. Eg: when OGTT's were more common apparently it was commonly understood that the patients should eat a lot of carbs the day before to avoid false positives; this is still part of the WHO etc guidelines.

I don't think the mechanisms are totally understood but part of it seems to be some kind of beta cell adaption, leading to impaired first phase insulin response.

This goes into some history, mechanisms etc: https://academic.oup.com/jes/article/5/5/bvab049/6199842

Unlike the primary beta cell defect observed in type 1 and type 2 diabetes, studies have demonstrated that the beta cell dysfunction caused by low-carbohydrate diets are likely reversible, as resumption of normal carbohydrate diet restores glucose homeostasis

 

[bulkbiker]

So physiological adaption to low carb diet => temporary impaired glucose tolerance has been recognised since the olden days. Eg: when OGTT's were more common apparently it was commonly understood that the patients should eat a lot of carbs the day before to avoid false positives; this is still part of the WHO etc guidelines.

Yet oddly I "passed" one without carbing up beforehand in the slightest.
I didn't test for ketones afterwards though.. maybe another is in order although I'm not sure a shot of 75g of glucose will do me much good.

 

[Deleted member 21371]

Yet oddly I "passed" one without carbing up beforehand in the slightest.
I didn't test for ketones afterwards though.. maybe another is in order although I'm not sure a shot of 75g of glucose will do me much good.

Strange how some things go.
Sometimes a unique thing happens?

 

[AndBreathe]

Strange how some things go.
Sometimes a unique thing happens?

I passed an OGTT too, without carbing up. I might have posted here about it. If not, I think I did on Redsville. You’d be able to find it, if interested.

Edited to correct the tyranny of autocorrect.

 

[Deleted member 21371]

I passed an OGTT too, without carving up. I might have posted here about it. If not, I think I did on Redsville. You’d be able to find it, if interested.

Well, you aced it on weight loss as well, if I remember correctly.

 

[Eddy Edson]

Yet oddly I "passed" one without carbing up beforehand in the slightest.
I didn't test for ketones afterwards though.. maybe another is in order although I'm not sure a shot of 75g of glucose will do me much good.

I don't think it's supposed to happen with everybody. Also, apparently it can depend on how robust the 2nd phase insulin response is - if really good, a 1st phase deficit might get masked. But like I said, I don't think the mechanisms are totally understood.

 

[AndBreathe]

Well, you aced it on weight loss as well, if I remember correctly.

Yes, I had already lost weight. The issue is not weightloss or remission in this fragment of this discussion, it was around tolerance of unexpected (to the body) carbs. Some find they have an unexpectedly poor response and some do OK. I was just posting my personal experience.

 

[AndBreathe]

I don't think it's supposed to happen with everybody. Also, apparently it can depend on how robust the 2nd phase insulin response is - if really good, a 1st phase deficit might get masked. But like I said, I don't think the mechanisms are totally understood.

In phsiological IR, I don't believe the 1st response is necessarily broken, more snoozing, waiting for the alarm.

 

[Deleted member 21371]

Yes, I had already lost weight. The issue is not weightloss or remission in this fragment of this discussion, it was around tolerance of unexpected (to the body) carbs. Some find they have an unexpectedly poor response and some do OK. I was just posting my personal experience.

Just wondering if the weight loss made it happen for you?
It was something like two and a half stones wasn't it?
You lost about 25% of your diagnosed weight and you went into remission?

Maybe that helped your insulin response, cleared the visceral fat?

 

[AndBreathe]

Just wondering it the weight loss made it happen for you?
It was something like two and a half stones wasn't it?
You lost about 25% of your diagnosed weight and you went into remission?

Maybe that helped your insulin response, cleared the visceral fat?

I have no idea what my weight loss was. I wasn't weighed at diagnosis and didn't weigh myself (for a number of reasons) for about 3 months after.

 

[42istheanswer]

Let's take a mere two billion of that. Let's recruit and train an army of specialist 'personal remission coaches'-- to provide psychological support and exercise support and nutrition support for people with T2D who are trying to achieve and maintain remission. And let's say we pay them a decent salary, say £40,000 a year.

For two billion pounds a year, we could get 50,000 of these people. If each of them was providing dedicated, intensive support to a group of 30 people with T2D-- they could be supporting 1.5 million people with T2D who genuinely want to try to achieve remission.

A) you want to pay them more than nurses? and B) you're forgetting associated employment costs other than direct pay - expenses, employers NI, employers pension contribution, HR etc

 

[Spathiphyllum]

A) you want to pay them more than nurses? and B) you're forgetting associated employment costs other than direct pay - expenses, employers NI, employers pension contribution, HR etc

Ok, let's pay nurses more. ; ) As for B), ok, let's do more work on the costings-- and also the savings ...

People with T2D are likely also to suffer from a range of other health conditions, physical and mental. Giving them the support they need to achieve T2D remission-- thus saving a lot of money on treatment of T2D in the long run-- will also enable them to lose weight and adopt healthier eating and exercise habits-- thus saving a lot of money on treatment of a range of other diseases in the long run. And the combination of becoming physically healthier, and in particular taking up exercise, with the psychologically beneficial experience of a period of intensive support is likely to yield savings on mental-health services too.

The important thing is the general principle. I think most health experts agree that we need to focus far, far more on preventive and primary care, and that, if we did, we would save a lot of money in the long run.