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Reducing risk of complications

J

JITR

Well-Known Member
Relationship to Diabetes
In remission from Type 2
Moderator note: A side conversation about complications risk was split away from this newbie
thread https://forum.diabetes.org.uk/boards/threads/hello.117391/#post-1436374

[snip] I followed the Newcastle Diet (real food < 800 cal) after my diagnosis. Designed for clinical trials and studies, that was a bit extreme. The good news from the studies is that all participants who lost weight and reduced glucose levels also seem to have reduced their risk of serious complications.
 
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JITR said:
Hello @Ian Robinson

Do you have your most recent blood result (HbA1c) and how does it compare with previous ones over the years? Could you do to lose some weight? In any case, diet is the key followed by whatever exercise you can manage. Your aim would be to see if you get your HbA1c down to less than 48-53 mmol/mol in say 6 months

In case it helps, I think good starting points are Dr David Unwin's successful diet sheet and Dr Kim Andrews' simple meal planner and red, amber, green food lists from Freshwell.

I followed the Newcastle Diet (real food < 800 cal) after my diagnosis. Designed for clinical trials and studies, that was a bit extreme. The good news from the study is that all participants who lost weight and reduced glucose levels also reduced their risk of serious complications. This applied both those with T2D for 10-25 years as wells the newly diagnosed.
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Which study ?
 
The trial showed that people who gained remission (Normal blood sugar levels) also showed an associated improvements with lipids and blood pressure, all of which reduce risk of future complications.
 
Burylancs said:
Which study ?
Click to expand...

There was a typo, 'the study' should have been 'the studies', now corrected in the post:
JITR said:
I followed the Newcastle Diet (real food < 800 cal) after my diagnosis. Designed for clinical trials and studies, that was a bit extreme. The good news from the studies is that all participants who lost weight and reduced glucose levels also reduced their risk of serious complications. This applied both those with T2D for 10-25 years as well as the newly diagnosed.
Click to expand...

The main study in question is DiRECT which followed on from Counterpoint.
 
JITR said:
There was a typo, 'the study' should have been 'the studies', now corrected in the post:


The main study in question is DiRECT which followed on from Counterpoint.
Click to expand...
The DiRECT 'study' was restricted to T2s under 6 years, it couldn't have shown benefits for 10 and 25 year duration T2s. In addition DiRECT specifically made no record of complications even over its 5 year reporting period - an egregious error since the impact of any management system on T2 complications is one of the most basic things we want to know. Lean and Taylor quoted the UKPDS and weakly assumed any improvement in control would lead to reduction in the risk of complications. Of course the UKPDS has been exposed as an example of classic 'bad science' by Ben Goldacre in his book Bad Pharma.
 
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Burylancs said:
The DiRECT 'study' was restricted to T2s under 6 years, it couldn't have shown benefits for 10 and 25 year duration T2s.
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Obviously, now you point it out. Thank you for the correction.
 
Yes, I saw that.

The book by Goldacre that mentions this study was Bad Pharma, not Bad Science. And its criticisms were mainly about the scrutiny required on large trials to ensure the conclusions are good, so the comment above is very misleading as 'Bad Science' is about quacks who sell vitamin supplements and homeopathy.

The study was highly influential and is still cited by the ADA, NICE, and WHO. And it was the study that led to the use of Metformin as a first line treatment.
 
Burylancs said:
The DiRECT 'study' was restricted to T2s under 6 years, it couldn't have shown benefits for 10 and 25 year duration T2s. In addition DiRECT specifically made no record of complications even over its 5 year reporting period - an egregious error since the impact of any management system on T2 complications is one of the most basic things we want to know. Lean and Taylor quoted the UKPDS and weakly assumed any improvement in control would lead to reduction in the risk of complications. Of course the UKPDS has been exposed as an example of classic 'bad science' by Ben Goldacre in his book Bad Science.
Click to expand...

harbottle said:
Yes, I saw that.

The book by Goldacre that mentions this study was Bad Pharma, not Bad Science. And its criticisms were mainly about the scrutiny required on large trials to ensure the conclusions are good, so the comment above is very misleading as 'Bad Science' is about quacks who sell vitamin supplements and homeopathy.

The study was highly influential and is still cited by the ADA, NICE, and WHO. And it was the study that led to the use of Metformin as a first line treatment.
Click to expand...
Ben Goldacre's criticism of UKPDS was that it used a particular trick. Studied four variables at once and then conflated the results and averaged them out. UKPDS studied laser treatment for retinopathy, cvd, neuropathy and kidney issues ( from memory). It found Good Control reduced the risk of complications by 22%. Good news and a basic glimmer of hope although it does suggest even with Good Control a T2 retains 78% of the risk of complications. Ben Goldacre dived into the detail and found that in UKPDS Good Control reduced the risk of laser treatment for retinopathy by 83% but for the other risks the reduction something like 2,1 and 2 %. Add the four figures together and get 88, divide by 4 and get 22% reduction in risk of complications with Good Control. The best news we've got but basically averaging results like that is a bit of a fiddle as Ben Goldacre pointed out. And his main aim was to call out that technique of massaging results not the UKPDS in particular. It's widely quoted because we've got precious little else to cheer us up.
 
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There have been other studies that have shown reductions in risks of complications, but you right, they did combine the variables (But you can see the individual variables and how much of a reduction of risk was obtained per 1mmol/mol reduction in hba1c if you furtle around on the internet.) They also had different treatments which showed different outcomes, with Metformin being the best.

That study was only on overweight patients and the recently diagnosed, I believe.

A US study showed that aggressive treatment on people who were eldery/frail or had the disease in its late stages was dangerous,
 
Burylancs said:
It found Good Control reduced the risk of complications by 22%. Good news and a basic glimmer of hope although it does suggest even with Good Control a T2 retains 78% of the risk of complications.
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How did they define "good control"? If it was purely HbA1c then we know that can be flawed because highs and lows can cancel each other out and result in a good HbA1c but I believe it is glucose variability/instability which is most likely to cause complications. I think with increased use of CGMs, better diabetes management can be achieved with less variability and perhaps result in improving those percentages of complication risk.
 
rebrascora said:
How did they define "good control"? If it was purely HbA1c then we know that can be flawed because highs and lows can cancel each other out and result in a good HbA1c but I believe it is glucose variability/instability which is most likely to cause complications. I think with increased use of CGMs, better diabetes management can be achieved with less variability and perhaps result in improving those percentages of complication risk.
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I believe good control was < 54 as this was the average of the ‘intensive’ therapy group. (They had two groups, intensive and non-intensive)

None of the treatments involved low carb diet, weight loss or exercise.
 
This 2024 paper 'Diabetes Distilled: UKPDS at 44 years' helps to explain why GPs are so keen to prescribe maximum doses of Metformin (to reduce cardivascular damages from 'spikes').

Looks like they are right to do so unless a patient agrees to follow:
1. A rapid weight loss programme for at least a week to see if that brings glucose levels down to normal.
2. If it does, a subsequent dietary programme to sustain normal levels and lose more weight to achieve and maintain an HbA1c target.
 
As usual I am the exception which tests the rule - since my attempt to use a shake and a small meal to lower my HbA1c last year, I noticed that my waist was expanding again. That is something I have seen every time I succeeded in losing a even a small amount of weight all my adult life when put on calorie controlled diets.
The initial weightloss after diagnosis and going low carb was no trouble to maintain, and my shape was altering year on year as I needed to make adjustments when I brought out my warm or cold weather clothing after 6 months stored away.
I stopped eating desserts and on alternate days did not eat any carbs at all for a few weeks until my waist began to shrink down - It was a modification of Atkins Induction - just as I had everything set up for a no more than 40gm of carbs a day, 40 one day and none the next gave an average of under 20 gm a day as per Atkins. I am still being a bit careful and eating about half the number of desserts as before, having salads and veges instead of berries.
The experiment actually resulted in an increased HbA1c - I think that the carbs in the shakes were too easily absorbed, so at my test in November I had a HbA1c of 48, which was a small but significant increase.
I did lose weight, I am sure, but I have always rebounded - for half a century.
My experiment seemed to prove what I have almost always known - that the laws of thermodynamics cannot be applied to a biological system.
 
Drummer said:
As usual I am the exception which tests the rule - since my attempt to use a shake and a small meal to lower my HbA1c last year, I noticed that my waist was expanding again. That is something I have seen every time I succeeded in losing a even a small amount of weight all my adult life when put on calorie controlled diets.
The initial weightloss after diagnosis and going low carb was no trouble to maintain, and my shape was altering year on year as I needed to make adjustments when I brought out my warm or cold weather clothing after 6 months stored away.
I stopped eating desserts and on alternate days did not eat any carbs at all for a few weeks until my waist began to shrink down - It was a modification of Atkins Induction - just as I had everything set up for a no more than 40gm of carbs a day, 40 one day and none the next gave an average of under 20 gm a day as per Atkins. I am still being a bit careful and eating about half the number of desserts as before, having salads and veges instead of berries.
The experiment actually resulted in an increased HbA1c - I think that the carbs in the shakes were too easily absorbed, so at my test in November I had a HbA1c of 48, which was a small but significant increase.
I did lose weight, I am sure, but I have always rebounded - for half a century.
My experiment seemed to prove what I have almost always known - that the laws of thermodynamics cannot be applied to a biological system.
Click to expand...
You don't seem like the exceotion. Your results seem to conform to expectations.
 
Drummer said:
... my attempt to use a shake and a small meal to lower my HbA1c last year ...
Click to expand...

At the time, as I recall, you reported your Thyroid had started working again. I wondered whether that was a factor, and I also wondered why you needed the shakes when you seemed happy with one meal a day.
 
JITR said:
Looks like they are right to do so unless a patient agrees to follow:
1. A rapid weight loss programme for at least a week to see if that brings glucose levels down to normal.
2. If it does, a subsequent dietary programme to sustain normal levels and lose more weight to achieve and maintain an HbA1c target.
Click to expand...

As a tiny detail I think some members would prefer the term recommended range or in range to describing glucose levels as ‘normal’
 
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