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International agreement on Remission

Oldvatr

Oldvatr

Expert
Messages
8,453
Type of diabetes
Type 2
Treatment type
Tablets (oral)
I said only yesterday that I thought the NHS was about to redefine the term Remission as applied to Type 2 diabetes, in line with what Roy Taylor has suggested. Guess what?
www.diabetes.org.uk

Experts agree global definition for type 2 diabetes remission

The ground-breaking findings from the Diabetes UK-funded DiRECT trial, which tested a low calorie, weight management programme in primary care, showed us that it’s possible for some people with type 2 diabetes to go into remission.
www.diabetes.org.uk www.diabetes.org.uk
 
Those reports are from August 2021.
Has anything changed since?
 
MrsA2 said:
Those reports are from August 2021.
Has anything changed since?
Click to expand...
Those were the most recent according to Dr Google. International agreements are not noted for quick reactions to changing circumstances. But Roy Taylor seems to be esconced in the debate at least according to DUK. org.
 
Here is the actual report, which identifies the international experts by name
link.springer.com

Consensus report: definition and interpretation of remission in type 2 diabetes - Diabetologia

Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often...
link.springer.com link.springer.com
It seems to be the latest release and has not been updated.
This report was also in the August 2021 Nursing Times.
 
The next formal NHS review is due Aug 2023. This may result in changes to NG28 from NICE, noting that the current version of the guidelines no longer discusses or mention remission or what should happen after remission in terms of ongoing support and monitoring. I seem to remember that the guidelines used to encourage ongoing checks after remission, but this seems to have been removed, That was in the day when remission was labelled Resolved in the medical records.

The only NHS discussion of remission I could find was 2019, and in the same document was telling T2 diabetics to eat Eatwell and have 3 meals a day with healthy snacks in between, which I am loathe to give a link to. I try to follow the maxim First Do No Harm.
 
Oldvatr said:
I said only yesterday that I thought the NHS was about to redefine the term Remission as applied to Type 2 diabetes, in line with what Roy Taylor has suggested. Guess what?
www.diabetes.org.uk

Experts agree global definition for type 2 diabetes remission

The ground-breaking findings from the Diabetes UK-funded DiRECT trial, which tested a low calorie, weight management programme in primary care, showed us that it’s possible for some people with type 2 diabetes to go into remission.
www.diabetes.org.uk www.diabetes.org.uk
Click to expand...

Interesting, my partner (a RN) said yesterday in response to me reading bits of that thread to her that she thought that in practise it had been this way for quite a while now, Admittedly I didn't look anything up to verify that.

I know the dietician I spoke with in the last few days said that 42-47 was considered in the pre-diabetic range, then again she sent me some spurious links to "cheat" pizzas, veggie sarnies. and pudding and snack recipes.
 
So I read it as a compromise - no Metformin allowed, but using 6.5% (48 in the UK) and for as little as 3 months rather than non-diabetic levels for 6 months or 1yr.
 
ianf0ster said:
So I read it as a compromise - no Metformin allowed, but using 6.5% (48 in the UK) and for as little as 3 months rather than non-diabetic levels for 6 months or 1yr.
Click to expand...
Yes that is the major change. It also reaffirms that it is non medicated. So the Roy Taylor defifinition did not get full acceptance, so yes, a compromise.

Looking at the work done by the USA panel prior to this report, they were still having difficulty in making allowances for those for whom the HbA1c test is invalid, which seems to have been finessed by these internalional experts. So those of us who have anemia or leukemia may find we can not claim remission.
 
Oldvatr said:
Yes that is the major change. It also reaffirms that it is non medicated. So the Roy Taylor defifinition did not get full acceptance, so yes, a compromise.

Looking at the work done by the USA panel prior to this report, they were still having difficulty in making allowances for those for whom the HbA1c test is invalid, which seems to have been finessed by these internalional experts. So those of us who have anemia or leukemia may find we can not claim remission.
Click to expand...
It also sits very well with the Newcastle diet. Get a result after three months.

I have always thought that some of this is taking place with an eye to incentivizing and monetising outcomes through the Quality and Outcomes Framework. Defining remission in this way is very convenient. It would be possible (once adopted) to set, measure, and reward a target of X% of T2 patients in the practice achieving remission.

In contrast, my practice used a definition of remission that is "a year out of diabetic and pre-diabetic range without medication".
 
KennyA said:
In contrast, my practice used a definition of remission that is "a year out of diabetic and pre-diabetic range without medication".
Click to expand...

Sounds a lot more sensible. For something that likely took very many years to develop a three month window to qualify for remission seems disproportionate to me.
 
For me, the issue is less whether official remission is recognised at <42 or <48 (although I prefer the former), but that there should be a measure for a sustained state.

It's all very well folks starving themselves ala ND, but then bouncing back to higher numbers once they are "in remission". Achieving a single result is one thing, maintaining it year or year is a different proposition.

(My records show resolved. 1673040411280.png)
 
AndBreathe said:
For me, the issue is less whether official remission is recognised at <42 or <48 (although I prefer the former), but that there should be a measure for a sustained state.

It's all very well folks starving themselves ala ND, but then bouncing back to higher numbers once they are "in remission". Achieving a single result is one thing, maintaining it year or year is a different proposition.

(My records show resolved. View attachment 58599)
Click to expand...
Indeed. The critical thing is to be able to maintain "change" over a period of years, rather than yo-yo around a chosen A1c value. Unfortunately it's much harder to devise a reward system for that - a further example of how our system funding drives behaviour in health services, sometimes in ways not best meeting the needs of those it serves.
 
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