Yet Another Newbie .. !

[everydayupsanddowns]

Ian-- there are "skinny Type 2 diabetics" in the sense of Type 2s who are not overweight in BMI terms, meaning they have BMIs of 25 or less. But, from what I've read, it is extremely rare for anyone with a BMI of less than 23 to develop Type 2 or even pre-Type 2.

I’m not sure it is quite as rare as you believe @Spathiphyllum

So much so, that Prof Taylor extended DIRECT with the ReTUNE study which specifically looked at whether remission through weight loss was possible for the 10% of T2s diagnosed who are neither overweight nor obese (so normal weight). Some people refer to TOFI (thin outside, fat inside).

ReTUNE study shows type 2 remission possible for people with lower body weight

While we know that obesity increases the risk of developing type 2 diabetes, 10% of people with type 2 diabetes have a BMI that is not in the obesity or overweight category.

www.diabetes.org.uk

I’m not sure whether this coincided with mentions of ‘personal fat threshold’. Or whether that terminology was already in circulation.

And 10% of the T2 population is a lot! Almost as many as there are people with T1 😱

Diabetes never did like playing by the rules! Even the ones it made up

 

[Spathiphyllum]

I’m not sure it is quite as rare as you believe @Spathiphyllum

So much so, that Prof Taylor extended DIRECT with the ReTUNE study which specifically looked at whether remission through weight loss was possible for the 10% of T2s diagnosed who are neither overweight nor obese (so normal weight). Some people refer to TOFI (thin outside, fat inside).

ReTUNE study shows type 2 remission possible for people with lower body weight

While we know that obesity increases the risk of developing type 2 diabetes, 10% of people with type 2 diabetes have a BMI that is not in the obesity or overweight category.

www.diabetes.org.uk

I’m not sure whether this coincided with mentions of ‘personal fat threshold’. Or whether that terminology was already in circulation.

And 10% of the T2 population is a lot! Almost as many as there are people with T1 😱

Diabetes never did like playing by the rules! Even the ones it made up

Yes, I know about the ReTUNE study. *But*-- as I think I've said previously, 'normal weight' in official BMI terms is 18.5-25. From what I've read, it is very rare for people with BMI under 23 to develop T2.

 

[Spathiphyllum]

Yes, I know about the ReTUNE study. *But*-- as I think I've said previously, 'normal weight' in official BMI terms is 18.5-25. From what I've read, it is very rare for people with BMI under 23 to develop T2.

And, looking into it further, it seems no actual article on these latest ReTUNE results has been published yet. The available information seems to be limited to the link you posted, and this, https://www.ncl.ac.uk/press/articles/latest/2022/04/diabetesremissionforlowbmi/ :

This study is defining people as 'not overweight' if they have a BMI under 27, and it says at these links that the average BMI of the 20 participants in the study was 24.8; no information is given regarding what the BMI was of the thinnest participant.

However, the person they pick out as their 'poster boy'-- "David’s story: Type 2 diabetes and thin"-- gives his story as follows: "I was a healthy 48-year-old with a BMI of 27." ...

Oh, and-- aha! The recently announced results are the results for how the study participants were doing after 12 months. But a little further searching reveals there was something published at an earlier stage of the ReTUNE study-- which says the BMIs of the participants ranged from 23.9 to 25.1: https://diabetesjournals.org/diabet...-P-Return-to-Normal-Glucose-Control-by-Weight

The ReTUNE study therefore provides no evidence at all that it is anything other than extremely rare for someone with a BMI under 23 to have Type 2.

Please keep in mind that there is a serious, widespread, well-known problem with misdiagnosis of older people, and this can cause very serious harm. Using the term 'thin' very loosely-- rather than looking more precisely at BMI-- simply adds to the problem and increases the risk of harm.

 

[ianf0ster]

I assume that all well informed people (i.e. most people on this forum) know that BMI can be fairly meaningless comparing 2 different people. It isn't a measure of fatness or lack of health. For example all heavyweight boxers, shot putters etc. are obese by definition even though their 'excess weight' is almost all muscle rather than fat.

It's quite well known that the body type of those from the Indian subcontinent is often associated with Type 2 Diabetes because although most have a low BMI, they carry some extra weight, in the form of fat, around the waist area and those organs in that area. That is the classic Skinny Type 2 diabetic body shape.

I'm not Asian and have no idea if I was pre-diabetic when I had a BMI of below 22, but I do know that I have not grown taller since back when I weighed 9t 3lbs which according to a BMI calculator (the NHS one is unavailable right now and being updated) is 19.7. Back then my brother (15 months younger) appeared fatter than me, but actually weighed around 7lbs less - so if I'd been similarly naturally light but with 7 lbs of fat around my middle I could quite easily been pre-diabetic at a BMI of less than 20.

 

[Macloud]

Sorry .. been out of loop for a few days.

Well, I have managed, inadvertently, to stir things up about T1 or T2 !

As a point of fact Mrs Macloud is actually 73 just now. And, as an additional complication (?) she has Parkinson's. So generous medication is spread throughout the waking day. In consequence of Parkinson's, the orthodox recommendation to exercise more is not really possible due to her dodgy balance problem; we don't want any more fractures really. And, yes, she also has osteoporosis ! So I am watching her food intake and dropping gentle hints as appropriate. And she has become more pro-active keeping me on the narrow path !

We are not too concerned about her HbA1c of 42 (or mine of 43) and have taken it just as a warning that something should be done. We are not monitoring blood glucose daily .. indeed, at all just now. We will request another HbA1c test in some 3 months time, to reassure ourselves that improvement is actually occurring. Left to our GP it would probably be 2024 ...

Thanks for all the advice, links and discussion. It is good to know that we are not alone !

M