Type 2 and insulin resistance - what I don't understand is...

[bulkbiker]

They eat cereal for breakfast, sandwiches for lunch, pasta, rice or potatoes with meat and veg for tea with cake, biscuits and fruit in between. They drink juice every day. A traditional diet.
As they have no medical reason to do, they do not count their carbs (or calories).

Then they are very lucky ..

 

[Deleted member 21371]

They eat cereal for breakfast, sandwiches for lunch, pasta, rice or potatoes with meat and veg for tea with cake, biscuits and fruit in between. They drink juice every day. A traditional diet.
As they have no medical reason to do, they do not count their carbs (or calories).

The same as everyone I know.
Parents, relatives, friends, even me. 🙂
My mum and dad had a Birds Eye diet.

 

[childofthesea43]

At the 1 year mark 47% (53%failure) of Taylors Intervention group were in remission on his definition. At 2 years 36% were in his definition of 'remission' (64%failures ). So it seems the benefits of the short sharp shock were washing out as the basics of the condition, chiefly insulin resistance, reasserted themselves. Taylor was saved by the pandemic ( or he hid behind it) and no reports on the 3 or 4 year stage were made. One suspects most of his guinea pigs were back on meds.
On the two year mark Taylor indulged in some statistical jiggery pokery ( a typical component of Bad Science) and declared 75% of the intervention group who had 'remission' at one year were stiil in remission ( that's the 47 % dropping to 36%). So Hey Presto, a 64% failure rate at 2 years is magically transformed into a 75% success rate !

Taylor’s use of the 75% figure is entirely correct and has no element of jiggery pokery. You are sloppily misrepresenting him. It was also shown that the fundamental reason for the remission drop at 2 years was owed to some regaining weight, as had been expected. I am an example of one who has regained no weight after achieving remission two years ago and have maintained A1c in the band 38 to 42, just as Taylor would have expected.

 

[Deleted member 21371]

Taylor’s use of the 75% figure is entirely correct and has no element of jiggery pokery. You are sloppily misrepresenting him. It was also shown that the fundamental reason for the remission drop at 2 years was owed to some regaining weight, as had been expected. I am an example of one who has regained no weight after achieving remission two years ago and have maintained A1c in the band 38 to 42, just as Taylor would have expected.

Respect to that.
I have the same weight profile.

 

[Eddy Edson]

Taylor’s use of the 75% figure is entirely correct and has no element of jiggery pokery. You are sloppily misrepresenting him. It was also shown that the fundamental reason for the remission drop at 2 years was owed to some regaining weight, as had been expected. I am an example of one who has regained no weight after achieving remission two years ago and have maintained A1c in the band 38 to 42, just as Taylor would have expected.

No weight regain for 4.5 years now and HbA1c in the low/mid 30's since then.

 

[Windy]

At the 1 year mark 47% (53%failure) of Taylors Intervention group were in remission on his definition. At 2 years 36% were in his definition of 'remission' (64%failures ). So it seems the benefits of the short sharp shock were washing out as the basics of the condition, chiefly insulin resistance, reasserted themselves. Taylor was saved by the pandemic ( or he hid behind it) and no reports on the 3 or 4 year stage were made. One suspects most of his guinea pigs were back on meds.
On the two year mark Taylor indulged in some statistical jiggery pokery ( a typical component of Bad Science) and declared 75% of the intervention group who had 'remission' at one year were stiil in remission ( that's the 47 % dropping to 36%). So Hey Presto, a 64% failure rate at 2 years is magically transformed into a 75% success rate !

If you compare it to the percentage of patients in remission reported in this:
Karter, A.J., Nundy, S., Parker, M.M., Moffet, H.H. and Huang, E.S., 2014. Incidence of remission in adults with type 2 diabetes: the diabetes & aging study. Diabetes Care, 37(12), pp.3188-3195.

Incidence of Remission in Adults With Type 2 Diabetes: The Diabetes & Aging Study - PMC

To estimate the incidence of remission in adults with type 2 diabetes not treated with bariatric surgery and to identify variables associated with remission. We quantified the incidence of diabetes remission and examined its correlates among 122,781 ...

www.ncbi.nlm.nih.gov

"The 7-year cumulative incidence of achieving any remission was 1.60% in the whole cohort (1.53–1.68%) and 4.6% in the subgroup with new-onset diabetes (<2 years since diagnosis) (4.3–4.9%). "

Taylor's reported 36% remission is still favourable compared to that reported in Karter et al 2014.

I don't see any statistical jiggery pokery, he's not hiding anything just reporting the percentage change. Perhaps it's better to celebrate the wins, and contextualise them against the previous remission which Karter reports at about 1.5% and just under 5%.

If I were a betting woman, I'd know which protocol I'd rather follow if I wanted to aim for remission.

 

[helli]

Then they are very lucky ..

Getting back to my question as it was not meant to be comparing you with my parents.

Why are some people more susceptible to weight gain (through whatever means) and others are not?

I don't believe it is purely down to luck but could believe there is something in our genes as I don't have any overweight grandparents, aunts, uncles, cousins, siblings, etc.
Or it could be something to do with our family values such as the love of outdoors.

 

[Burylancs]

If you compare it to the percentage of patients in remission reported in this:
Karter, A.J., Nundy, S., Parker, M.M., Moffet, H.H. and Huang, E.S., 2014. Incidence of remission in adults with type 2 diabetes: the diabetes & aging study. Diabetes Care, 37(12), pp.3188-3195.

Incidence of Remission in Adults With Type 2 Diabetes: The Diabetes & Aging Study - PMC

To estimate the incidence of remission in adults with type 2 diabetes not treated with bariatric surgery and to identify variables associated with remission. We quantified the incidence of diabetes remission and examined its correlates among 122,781 ...

www.ncbi.nlm.nih.gov

"The 7-year cumulative incidence of achieving any remission was 1.60% in the whole cohort (1.53–1.68%) and 4.6% in the subgroup with new-onset diabetes (<2 years since diagnosis) (4.3–4.9%). "

Taylor's reported 36% remission is still favourable compared to that reported in Karter et al 2014.

I don't see any statistical jiggery pokery, he's not hiding anything just reporting the percentage change. Perhaps it's better to celebrate the wins, and contextualise them against the previous remission which Karter reports at about 1.5% and just under 5%.

If I were a betting woman, I'd know which protocol I'd rather follow if I wanted to aim for remission.

The importAnt comparison we should be making is actually missing from Taylor's PR handouts. The comparison between his intervention group and his control group. We just don't know how his control group performed on the major measures. How did control and intervention perform on kidney function for example. We just don't know because no proper academic report on the DiRECT trial has been published. Taylor carefully cherry picked his control group so as to exclude anyone who might prove his pet theories wrong e.g. t2s over 6 years and t2s on insulin ( he must suspected t2s managing the condition with insulin would have knocked his crash diet into. a cocked hat).
It's another wheeze of Bad Science - just to report on the doings of the Intervention group and consign the Control Group to Davy Jones's Locker with no honest and objective comparison tables of the two groups on key measures.

 

[harbottle]

There has to be some sort of selection criteria, and it's known that the longer someone has T2D the worse it will be.

You could hardly take someone who is on insulin to manage their blood sugar and tell them to stop it and go on a crash diet so we can 'see what happens.' That would be irresponsible, and also pointless, as by the time a T2 is using insulin it means they are no longer producing enough insulin to overcome the basal production from the liver.

I suspect there's a reason why you're so angry by this research and keep trying to pick holes in.

 

[rebrascora]

There have been quite a few instances where long standing Type 2 diabetics on insulin have followed a low carb higher fat way of eating and come off insulin and indeed all diabetes meds (not sure there are any scientific studies), so I do think there is more than one way to approach this and if there is a group that Prof Taylor's report believes are not responsive to his approach, then there is that option to try rather than give up hope.

I too wonder why @Burylancs is so antagonistic towards Prof Taylor's work or any suggestion that Type 2 may not be progressive?

 

[bulkbiker]

That would be irresponsible, and also pointless, as by the time a T2 is using insulin it means they are no longer producing enough insulin to overcome the basal production from the liver.

Odd then that ViRTA in their ketogenic diet trial didn't have any such exclusion criteria yet had similar results to Taylor et al?
I really wish people would stop saying that T2's "aren't producing enough insulin" ... they are (probably too much in fact), it's just that their insulin resistance is not letting it "work" correctly.

 

[bulkbiker]

The importAnt comparison we should be making is actually missing from Taylor's PR handouts. The comparison between his intervention group and his control group. We just don't know how his control group performed on the major measures. How did control and intervention perform on kidney function for example. We just don't know because no proper academic report on the DiRECT trial has been published. Taylor carefully cherry picked his control group so as to exclude anyone who might prove his pet theories wrong e.g. t2s over 6 years and t2s on insulin ( he must suspected t2s managing the condition with insulin would have knocked his crash diet into. a cocked hat).
It's another wheeze of Bad Science - just to report on the doings of the Intervention group and consign the Control Group to Davy Jones's Locker with no honest and objective comparison tables of the two groups on key measures.

It also fascinates me that, I think it was 6, people in the control group managed to put their T2 into remission by not starving themselves.. Taylor spends little to no time looking at how or why that was the case. Odd, I have always thought.

 

[Burylancs]

It also fascinates me that, I think it was 6, people in the control group managed to put their T2 into remission by not starving themselves.. Taylor spends little to no time looking at how or why that was the case. Odd, I have always thought.

Actually I think the figure of 4 was mentioned in his 2018 Lancet article and that mysteriously jumped to 4% in later versions. Are they just making stuff up as they go along ?

 

[Deleted member 21371]

It also fascinates me that, I think it was 6, people in the control group managed to put their T2 into remission by not starving themselves.. Taylor spends little to no time looking at how or why that was the case. Odd, I have always thought.

"Practices randomised to the control group continued to deliver usual diabetes and weight management as per current clinical guidelines."

Current guidelines must work, just not as well, I guess.
I followed them originally and also lost weight that way.
Just not down to my personal threshold it would seem.

 

[bulkbiker]

Actually I think the figure of 4 was mentioned in his 2018 Lancet article and that mysteriously jumped to 4% in later versions. Are they just making stuff up as they go along ?

After 1 year it was reported as 5 out of 149

Can't find the 2 year number although I did find this statement quite interesting

" Many of the participants in remission from diabetes in DiRECT had HbA1c in the range of ‘prediabetes’ (42–48 mmol/mol [6.0–6.5%])."

Wonder how many "many" is...

 

[Callista]

Isn't the general point that it does seem that there are more than one way to tackle T2, and it can be individual according to that individual's personal metabolism, and, too, what they can cope with and manage long term?

 

[Deleted member 21371]

Isn't the general point that it does seem that there are more than one way to tackle T2, and it can be individual according to that individual's personal metabolism, and, too, what they can cope with and manage long term?

It certainly is that 🙂

 

[Callista]

I think (I hope!) that it's a question of trying to work 'with' ourselves, rather than 'against' ourselves.

 

[bulkbiker]

Getting back to my question as it was not meant to be comparing you with my parents.

Why are some people more susceptible to weight gain (through whatever means) and others are not?

I don't believe it is purely down to luck but could believe there is something in our genes as I don't have any overweight grandparents, aunts, uncles, cousins, siblings, etc.
Or it could be something to do with our family values such as the love of outdoors.

Personally I think its a combination of what we eat with maybe some genetic input.
I fatten up easily so maybe that would have helped me survive cold winters.
I've always eaten quite good quality food but probably of the wrong type (I think).
Could it be seed oils too or maybe a combination of all three.
All I know is by virtually removing carbohydrates from my diet a host of health issues disappeared completely.

 

[Deleted member 21371]

I think (I hope!) that it's a question of trying to work 'with' ourselves, rather than 'against' ourselves.

I've been doing it for around eleven years now, so I think you are right.