Tips to keep in remission

[Dragonheart]

Yup. When they set out they set a target for a primary care based intervention that, if exceeded, would make it a worthwhile program to roll out. From Taylor's book:

"We planned DiRECT with the aim of achieving a clinically important result. We decided that releasing one in five people from diabetes, off all tablets, at one year, would be very useful - important for each individual, and important for the costs of providing healthcare".

They did that much and more, and the support wasn't particularly extensive. There was support yes, but the aim of the study was to test if it could be done in a primary care setting and so *without* extensive and thus expensive support.

I think they did a pretty good job for a first time effort. Personally I wonder what would happen if you repeated it but put everyone on Ozempic to help them keep the weight off and to push HbA1c down a bit more than is strictly necessary to go off the tablets. That would be an expensive programme though, at least for the time being, and unlikely to get an NHS rollout.

So actually it’s not true to say 7% at 5yrs exceeded the goal.
20% at 1 yr would though.

Quite a difference. And I do agree 20% (or more) is a worthy result, just a shame it’s so temporary by this method.

 

[JITR]

7% remission at 5 yrs with all the extensive support being part of a trial provides is exceeding expectations?

The received wisdom at the time, T2D is a progressive condition one has to live with. Roy Taylor's Counterpoint study in 2007-8 proved it to be reversible by eliminating excess fat in the liver and pancreas, see his video above. The DiRECT study was to test the feasibility of the NHS rolling out a remission programme, the NHS Path to Remission due to be nationally available this year. Mike Lean described the expectations in his video above.

I have no idea what happened to the 93% but the trial cannot be held responsible for them losing conatct or falling by the wayside. The positive is that 100% known to have gone into remission and maintained their new weight stayed in remission year on year.

Even if only 7% of the 150,000 odd newly diagnosed T2 every year were to stay in remission for life, over 10,000 would be no longer be a burden on NHS and themselves. The NHS Path to Remission programme indicates over 90% could potentially follow that route. The challenge is to help us all to achieve that goal. Susan Jebb's New Dawn project, funded by Diabetes UK, is a step towards that goal.

In his video presentation above, David Unwin mentions an astounding statistic. The success rate with pre-diabetics at the Norwood surgery is 93%. That should become a national target. It would reduce the 150,000 new T2 cases per annum to about 10,000.

 

[everydayupsanddowns]

The positive is that 100% known to have gone into remission and maintained their new weight stayed in remission year on year.

It does seem to the maintaining of the new weight that is important with responders to the DIRECT approach

 

[JITR]

It does seem to the maintaining of the new weight that is important with responders to the DIRECT approach

Yes, that's right, and it's the same for any weight loss any T2 diabetic achieves. Put it all back, as often happens after a diet (as in yo-yo dieting), and your T2 will return.

As you know the DiRECT approach was to study the feasibility of rolling out a managed programme based on the Counterpoint study that proved that T2D was a reversible condition. It is not so well known that, after publication of the Counterpoint results, the Magnetic Resonance Centre at Newcastle University received a thousand or more people interested in reversing their condition. Many succeeded on their own initiative and Professor Taylor and his team published a Short Report on the outcomes.

Here is the opening paragraph:

Publication about reversibility of Type 2 diabetes using avery low energy diet (the Counterpoint study [1]) was followed by over 1000 enquiries from people with diabetes. The overwhelming sentiment expressed was profound relief at the possibility that the condition was not inevitably permanent. The extent of public interest prompted the authors to make available on a website general informationabout reversing diabetes, both for people with Type 2 diabetes and healthcare professionals [2]. In this, it isexplained that a very low energy diet was chosen in the research study to mimic the effects of gastric bypass surgery. However, steady but substantial weight loss achieved by reducing portion size was recommended as the preferred method. The focus was on the need to achieve substantialand sustainable weight loss through the best approach for that individual. All individuals were advised to discuss their plans for energy restriction with their own doctor, particularly with a view to adjusting anti-diabetic medication. A separate document with information for doctors was available. No alterations to habitual physical activity levels wereadvised. Within a few months individuals began to feed backtheir personal experiences of attempting to reverse their diabetes. We have collated this information, which provides a unique demonstration of what is achievable by energy restriction in motivated individuals outside a research setting.

... and the concluding paragraph:

These data demonstrate that intentional weight loss achieved at home by health-motivated individuals can reverse Type 2 diabetes. Diabetes reversal should be a goal in the management of Type 2 diabetes in these individuals.The durability of the effect on glucose metabolism requires further study. Long-term avoidance of weight gain must be the top priority after reversal of diabetes, and the dietary regimen best able to achieve this must now be established.
Establishing the 'dietary regimes best able to achieve long-term avoidance of weight gain' not only for the New Dawn managed programme but also the many T2 diabetics and pre-diabetics who want to do it themselves. I'd suggest a 'concerted action' drawing together all interested agencies and experts could achieve this.

Meanwhile, after losing 22 kg on my real food version of the Newcastle Diet, I have delegated responsibility for my dietary regime to my 32" trousers

Short Report: Treatment. Population response to information on reversibility ofType 2 diabetes: https://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/counterpoint-study.pdf

 

[AndBreathe]

Yup. When they set out they set a target for a primary care based intervention that, if exceeded, would make it a worthwhile program to roll out. From Taylor's book:

"We planned DiRECT with the aim of achieving a clinically important result. We decided that releasing one in five people from diabetes, off all tablets, at one year, would be very useful - important for each individual, and important for the costs of providing healthcare".

They did that much and more, and the support wasn't particularly extensive. There was support yes, but the aim of the study was to test if it could be done in a primary care setting and so *without* extensive and thus expensive support.

I think they did a pretty good job for a first time effort. Personally I wonder what would happen if you repeated it but put everyone on Ozempic to help them keep the weight off and to push HbA1c down a bit more than is strictly necessary to go off the tablets. That would be an expensive programme though, at least for the time being, and unlikely to get an NHS rollout.

I don’t think we can call the Taylor/Lean work a first time effort, bearing in mind, Taylor ran a bit of an observational study on folks he was seeing through his imaging for some time beforehand, plus his much smaller studies, to gain funding for the biggie.

 

[AndBreathe]

It does seem to the maintaining of the new weight that is important with responders to the DIRECT approach

I think weight maintenance, in a decent zone would help with most metabolic disorders - almost irrespective of how that “healthy weight” is achieved.

 

[Burylancs]

Yup. When they set out they set a target for a primary care based intervention that, if exceeded, would make it a worthwhile program to roll out. From Taylor's book:

"We planned DiRECT with the aim of achieving a clinically important result. We decided that releasing one in five people from diabetes, off all tablets, at one year, would be very useful - important for each individual, and important for the costs of providing healthcare".

They did that much and more, and the support wasn't particularly extensive. There was support yes, but the aim of the study was to test if it could be done in a primary care setting and so *without* extensive and thus expensive support.

I think they did a pretty good job for a first time effort. Personally I wonder what would happen if you repeated it but put everyone on Ozempic to help them keep the weight off and to push HbA1c down a bit more than is strictly necessary to go off the tablets. That would be an expensive programme though, at least for the time being, and unlikely to get an NHS rollout.

Yes, that's right, and it's the same for any weight loss any T2 diabetic achieves. Put it all back, as often happens after a diet (as in yo-yo dieting), and your T2 will return.

As you know the DiRECT approach was to study the feasibility of rolling out a managed programme based on the Counterpoint study that proved that T2D was a reversible condition. It is not so well known that, after publication of the Counterpoint results, the Magnetic Resonance Centre at Newcastle University received a thousand or more people interested in reversing their condition. Many succeeded on their own initiative and Professor Taylor and his team published a Short Report on the outcomes.

Here is the opening paragraph:

Publication about reversibility of Type 2 diabetes using avery low energy diet (the Counterpoint study [1]) was followed by over 1000 enquiries from people with diabetes. The overwhelming sentiment expressed was profound relief at the possibility that the condition was not inevitably permanent. The extent of public interest prompted the authors to make available on a website general informationabout reversing diabetes, both for people with Type 2 diabetes and healthcare professionals [2]. In this, it isexplained that a very low energy diet was chosen in the research study to mimic the effects of gastric bypass surgery. However, steady but substantial weight loss achieved by reducing portion size was recommended as the preferred method. The focus was on the need to achieve substantialand sustainable weight loss through the best approach for that individual. All individuals were advised to discuss their plans for energy restriction with their own doctor, particularly with a view to adjusting anti-diabetic medication. A separate document with information for doctors was available. No alterations to habitual physical activity levels wereadvised. Within a few months individuals began to feed backtheir personal experiences of attempting to reverse their diabetes. We have collated this information, which provides a unique demonstration of what is achievable by energy restriction in motivated individuals outside a research setting.

... and the concluding paragraph:

These data demonstrate that intentional weight loss achieved at home by health-motivated individuals can reverse Type 2 diabetes. Diabetes reversal should be a goal in the management of Type 2 diabetes in these individuals.The durability of the effect on glucose metabolism requires further study. Long-term avoidance of weight gain must be the top priority after reversal of diabetes, and the dietary regimen best able to achieve this must now be established.
Establishing the 'dietary regimes best able to achieve long-term avoidance of weight gain' not only for the New Dawn managed programme but also the many T2 diabetics and pre-diabetics who want to do it themselves. I'd suggest a 'concerted action' drawing together all interested agencies and experts could achieve this.

Meanwhile, after losing 22 kg on my real food version of the Newcastle Diet, I have delegated responsibility for my dietary regime to my 32" trousers

Short Report: Treatment. Population response to information on reversibility ofType 2 diabetes: https://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/counterpoint-study.pdf

Taylor abandoned the term 'reversing' in 2017 and switched to 'remission'. He realised he could never be taken seriously if he persisted with such a claim. And ADA has recently ruled that 'there is no such thing' as reversing Type 2 Diabetes. The condition is 'inevitably permanent' in the current state of knowledge.

 

[PerSpinasAdAstra]

I don’t think we can call the Taylor/Lean work a first time effort, bearing in mind, Taylor ran a bit of an observational study on folks he was seeing through his imaging for some time beforehand, plus his much smaller studies, to gain funding for the biggie.

Point taken. A first time effort at a mass rollout prototype is what I was aiming for. DiRECT was a 'world first' attempt (as far as I'm aware) to bring about remission in a primary care setting. Here's to hoping that the next attempt, by whomever undertakes it, leads to long-term remission (or at least a big step in the right direction).

 

[PerSpinasAdAstra]

Taylor abandoned the term 'reversing' in 2017 and switched to 'remission'. He realised he could never be taken seriously if he persisted with such a claim. And ADA has recently ruled that 'there is no such thing' as reversing Type 2 Diabetes. The condition is 'inevitably permanent' in the current state of knowledge.

His book is titled 'Life Without Diabetes - The definitive guide to understanding and reversing type 2 diabetes'. Copyright Roy Taylor 2020.

There is power in language. It motivates. Inspires action. Hardens resolve.

I see no harm in the word 'reverse' if it brings about positive change. I spent two hours today in a waiting room, between my podiatrist appointment and an unexpected consultation with a consultant diabetologist/endocrinologist who happened to be in the building. In that time I observed other diabetics of various ages, including a man who couldn't walk without two crutches and even then moved very slowly, but did not look like he was over the age of maybe 55 years old. If the word 'reversing' helps to get Taylor's book into the hands of a younger version of that man then I'm all for it.

 

[AndBreathe]

Point taken. A first time effort at a mass rollout prototype is what I was aiming for. DiRECT was a 'world first' attempt (as far as I'm aware) to bring about remission in a primary care setting. Here's to hoping that the next attempt, by whomever undertakes it, leads to long-term remission (or at least a big step in the right direction).

I think thousands of patients, in primary care had been trying that for years. David Unwin and colleagues have also been working with their patients with similar aims for years.

One would like to think thousands of GPs would also claim the same, although mine would be hard pressed, I fear. Pity really.

 

[JITR]

I think thousands of patients, in primary care had been trying that for years. David Unwin and colleagues have also been working with their patients with similar aims for years. One would like to think thousands of GPs would also claim the same, although mine would be hard pressed, I fear. Pity really.

That's why the 150,000 people who are diagnosed T2D each year, and pre diabetics, need unambiguous published guidelines on how and why they need to lose weight and keep it off. These would educate GPs and DNs as well. The UK has failed to implement the WHO 2020 T2D protocol, diet to achieve an agreed target and introduce Metformin only when that fails. High time to catch up.

 

[AndBreathe]

That's why the 150,000 people who are diagnosed T2D each year, and pre diabetics, need unambiguous published guidelines on how and why they need to lose weight and keep it off. These would educate GPs and DNs as well. The UK has failed to implement the WHO 2020 T2D protocol, diet to achieve an agreed target and introduce Metformin only when that fails. High time to catch up.

There are plenty of guidelines out there on how to lose weight, published by many organisations. Staying trim is not just about diabetes. Carrying extra weight can have longer term implications for all manner of health concerns.

Keeping weight off? That's not rocket science. Simply don't do what you did to gain the weight in the first place. (Of course, that's very simplistic, but how many volumes do you want these guidelines to be?)

Has any country implemented the WHO 2020 T2D protocol?

 

[JITR]

I think thousands of patients, in primary care had been trying that for years. David Unwin and colleagues have also been working with their patients with similar aims for years. One would like to think thousands of GPs would also claim the same, although mine would be hard pressed, I fear. Pity really.

That's why the 150,000 people who are diagnosed T2D each year, and pre diabetics, need unambiguous published guidelines on how and why they need to lose weight and keep it off.

There are plenty of guidelines out there on how to lose weight, published by many organisations. Staying trim is not just about diabetes. Carrying extra weight can have longer term implications for all manner of health concerns.

No standard guidelines yet from the NHS/GPs/DNs or Diabetes UK for the 150,000 newbies and others who want to self manage their remission. The New Dawn project is a step in the right direction:

£2.2 million NewDAWN project to help more people go in to remission

Our type 2 diabetes remission research A diagnosis of type 2 diabetes once meant the start of a lifelong journey of learning to live with a serious condition that can have a big impact on health and wellbeing.

www.diabetes.org.uk

Has any country implemented the WHO 2020 T2D protocol?

David Unwin has, but NICE and GPs who follow their guidelines have not. Roy Taylor and his team proved T2D is a result of a fatty liver in 2008. 14 years later my GP said I must take Metformin. The next day a radiographer detected my fatty liver and advised diet. I downloaded Cronometer to keep an eye on nutrients and started on my version of the Newcastle diet at once.

 

[Burylancs]

That's why the 150,000 people who are diagnosed T2D each year, and pre diabetics, need unambiguous published guidelines on how and why they need to lose weight and keep it off.

No standard guidelines yet from the NHS/GPs/DNs or Diabetes UK for the 150,000 newbies and others who want to self manage their remission. The New Dawn project is a step in the right direction:

£2.2 million NewDAWN project to help more people go in to remission

Our type 2 diabetes remission research A diagnosis of type 2 diabetes once meant the start of a lifelong journey of learning to live with a serious condition that can have a big impact on health and wellbeing.

www.diabetes.org.uk

David Unwin has, but NICE and GPs who follow their guidelines have not. Roy Taylor and his team proved T2D is a result of a fatty liver in 2008. 14 years later my GP said I must take Metformin. The next day a radiographer detected my fatty liver and advised to diet. I downloaded Cronometer keep an eye on nutrients and started on my version of the Newcastle diet.

A step forward in that they have more or less put Taylor in his place, perhaps disappointed at his 93% failure rate in the medium term, and are looking at a variety of weight loss schemes. Diet and Exercise has been the initial prescription for T2s for the past 70 years but has I have been complaining for the last 32 years there has been no actual plan of D&E for newbies, it was just a vacuity. 'Remission' remains an inappropriate term for Type 2 Diabetes, however, which has to be managed every day, every meal , every mouthful for the rest of your life once diagnosed. There could be no complaint about any of these well-meant schemes if the words Good Control or Good Management was used. When you look at the routines of folks on here who claim to be in remission or reversed their T2 condition it's obvious that they are actually slaves to it.

 

[trophywench]

But some people just are not persuaded that they CAN eat less. One couple we have known for years (though never big mates with them, we don't have the same interests in the main) she'd lost a lot of weight when we saw em last year. We didn't even know she had T2. Oh yes, it's this new drug the Dr has prescribed for me. I've never been able to lose weight before for the reason that everyone knows from birth that if you feel hungry, you eat - and I've never been able to stop myself feeling hungry before!

She still attributes it purely to the drug, not her eating less crap. At a coffee morning where there were a tin of biscuits offered she went for a jammy dodger and a custard cream whereas I said where are the plain ones? I do actually like a jammy dodger, but loathe custard creams, just Yuk, so never chose one of them in my life. I just thought, you clearly ain't learned much have you. Ah well.

You cannot control blood glucose - attempting to do that is doomed to failure. However - you can manage it!

 

[AndBreathe]

That's why the 150,000 people who are diagnosed T2D each year, and pre diabetics, need unambiguous published guidelines on how and why they need to lose weight and keep it off.

No standard guidelines yet from the NHS/GPs/DNs or Diabetes UK for the 150,000 newbies and others who want to self manage their remission. The New Dawn project is a step in the right direction:

£2.2 million NewDAWN project to help more people go in to remission

Our type 2 diabetes remission research A diagnosis of type 2 diabetes once meant the start of a lifelong journey of learning to live with a serious condition that can have a big impact on health and wellbeing.

www.diabetes.org.uk

David Unwin has, but NICE and GPs who follow their guidelines have not. Roy Taylor and his team proved T2D is a result of a fatty liver in 2008. 14 years later my GP said I must take Metformin. The next day a radiographer detected my fatty liver and advised diet. I downloaded Cronometer to keep an eye on nutrients and started on my version of the Newcastle diet at once.

With respect, whilst the majority of T2s become T2 due to an overload of fat cells around the relevant organs, there are those who become T2 after cancer treatment, statins and several other reasons. Of course, perhaps they need to be categorised differently, but in most cases, they simply aren't

 

[AndBreathe]

A step forward in that they have more or less put Taylor in his place, perhaps disappointed at his 93% failure rate in the medium term, and are looking at a variety of weight loss schemes. Diet and Exercise has been the initial prescription for T2s for the past 70 years but has I have been complaining for the last 32 years there has been no actual plan of D&E for newbies, it was just a vacuity. 'Remission' remains an inappropriate term for Type 2 Diabetes, however, which has to be managed every day, every meal , every mouthful for the rest of your life once diagnosed. There could be no complaint about any of these well-meant schemes if the words Good Control or Good Management was used. When you look at the routines of folks on here who claim to be in remission or reversed their T2 condition it's obvious that they are actually slaves to it.

The thing about a plan of D&E for folks is that one size (diet or exercise included) does not fit all.

Some will happily trim up and go to remission by Slimming World, for others it might needs the shakes and soups of kketo style diets, and that's ignoring exercise.

Pre-diagnosis, I could almost have been a poster girl for NHS living. A good, varied diet, with "plenty carbs" of all colours and very active. Clearly, it didn't work for me.

In there, it is surely important that people are given choice, and the option to make their own choices for D&E. Lifestyle can facilitate and create barriers to successful outcomes.

If I had still been on the corporate treadmill when diagnosed (I had just stepped off), keto and fasting would have worked well for me, due to long days of back to back meetings and long commutes, whereas when I was off that treadmill a low carb approach worked out well for me.

One thing I do feel concerned about are programmes labelled, such as "Path the Remission". What about those poor sods who stick to it slavishly and still continue to live squarely in the T2 ranges. Are THEY failures, or is the prescribed approach failed them? That's rhetorical really, but not too uplifting for those folks, and possibly heighten their chances of reaching for a comforting doughnut (or whatever).

 

[JITR]

With respect, whilst the majority of T2s become T2 due to an overload of fat cells around the relevant organs, there are those who become T2 after cancer treatment, statins and several other reasons. Of course, perhaps they need to be categorised differently, but in most cases, they simply aren't

What is the estimated percentage of newly diagnosed who have the other conditions you mention? Dr David Unwin reports a 93% success rate with prediabetics when talking about low carb diets. No mention of other causes.

 

[AndBreathe]

No idea. Without a doubt, there is room for guidance in all of this, but one size doesn't fit all and not everyone is capable of achieving that remission state.

For those people, there has to be some form of recognition they did their best, and not just label them failures.

Frankly, this comes down to HCP training, and the use of appropriate HCPs delivering care, taking bloods and so on. Labelling someone the Diabetes Nurse, just because they drew the short straw when drawing lots for clinics is unhelpful.