Direct Study - 5 Year Follow Up

[Ronancastled]

https://www.diabetes.org.uk/about_u...ssion-least-five-years-reveal-latest-findings

https://twitter.com/x/status/1648574761973293056

This hit the news channels yesterday, only picking up on it now.
Not as inspiring as I might have hoped.



Think I remember the initial headline data spoke about 76% achieving remission with 15kg weight loss.
Obviously those large weight loss amounts have tapered over time, would like to see a more detailed analysis of those 11 remaining successful candidates .
Weight loss may be the key for obese T2s but maintaining seems a greater struggle.

 

[Oldvatr]

And this

University of Glasgow - University news - Archive of news - 2023 - April - Weight loss can put type 2 diabetes into remission for at least five years

www.gla.ac.uk

The Beeb carried this story last night with graphic details of what happens if you do not get your diabetes under control
for instance, they listed the following:
180 amputations a week
470 strokes a week
600 heart attacks a week
£10k a week costs to NHS

They interviewed one of the paricipants who did the original ND trial. They showed him testing, and the reading was 7.9 meanwhile the voiceover was extolling how he had gone into remission and was no longer taking insulin. Then they showed him eating a healthy meal of 1 green apple. They did not show any test results after, so it is not clear if the one he was shown demonstrating was pre or post prandial. But it shows his diabetes may be in control but that it is still lurking.

So it works for 23% of the original study who originally had to lose 15% of body mass, and now seem to maintian at 8.9 kg less. Not clear if that is additional loss on the 15% or is actual loss from the starting value ( it is identified as a 5 year average loss).

For what its worth my own jouney started LCHF with a loss of approx 50kg and I have maintined my weight at 64 kg without counting a single calorie or starving myself on rabbit food. And there are no shakes on me. And I am an elderly couch potato so no exercise either. I still Bant.

Edit to add there are hints that many of the participants had to re run the 800 cal diet several times to keep their weight down. But hats off to them, they persisted for 7 years now. On ultra low calorie and ultra low fat diet out of a tin.

 

[ianf0ster]

I strongly suspect that Dr Unwin's patients on Low Carb have a better remission rate after 5yrs.

 

[Oldvatr]

https://www.diabetes.org.uk/about_u...ssion-least-five-years-reveal-latest-findings

https://twitter.com/x/status/1648574761973293056

This hit the news channels yesterday, only picking up on it now.
Not as inspiring as I might have hoped.

View attachment 60476

Think I remember the initial headline data spoke about 76% achieving remission with 15kg weight loss.
Obviously those large weight loss amounts have tapered over time, would like to see a more detailed analysis of those 11 remaining successful candidates .
Weight loss may be the key for obese T2s but maintaining seems a greater struggle.

The headline yu remember I think was 46% on 15% loss from the original study.It was just kess than half were classed as Responders. I think DIRECT (whch became a two pass solution) did raise this by a small amount but it was still around 50%. It was certainly clarioned that the weight loss had to be around 15%

 

[Oldvatr]

I strongly suspect that Dr Unwin's patients on Low Carb have a better remission rate after 5yrs.

Don't forget either that the ND diet based on shakes is also LC but not HF. It was designed to run so that the majority just avoided going into ketosis.

 

[Ronancastled]

So it works for 23% of the original study who originally had to lose 15% of body mass, and now seem to maintian at 8.9 kg less. Not clear if that is additional loss on the 15% or is actual loss from the starting value ( it is identified as a 5 year average loss).

So there was 68 people out of 149 who maintained remission at 1 year.



So that 68 decayed to 48 at Year 2 & further to only 11 at Year 5.



So there is the real headline figure.
The real takeaway here is the difficulty in maintaining the weight loss.
Perhaps this strengthens Taylor's hypothesis

 

[Oldvatr]

View attachment 60479
So there was 68 people out of 149 who maintained remission at 1 year.

View attachment 60478

So that 68 decayed to 48 at Year 2 & further to only 11 at Year 5.

View attachment 60480

So there is the real headline figure.
The real takeaway here is the difficulty in maintaining the weight loss.
Perhaps this strengthens Taylor's hypothesis

It does look like taking the ND original startpoint the interevention had a 5 year success rate of 11 out of 149 i.e. 7% in remisssion due to the diet. Looking less impressive every time they trumpet success. I suggest the Unwin trials may very well be more rewarding.

I did consider doing a quiz on this site for LCHF, but I suspect that many of those gaining success will have dropped off the forum so would not respond. I can certainly claim 7 years now. The Taylor definition of remission is HbA1c below 48. and that is with or without meds.

 

[Ronancastled]

It does look like taking the ND original startpoint the interevention had a 5 year success rate of 11 out of 149 i.e. 7% in remisssion due to the diet. Looking less impressive every time they trumpet success.

Also worth noting that those original 149 were specially chosen too, <6 years T2 duration, BMI > 27, no insulin users.
Funnily enough that 7% success rate isn't far off the 5% observed by all T2s in the 2019 Scottish study.

https://pubmed.ncbi.nlm.nih.gov/34727107/

Only positive takeaway for Taylor is that the weight loss hypothesis appears to be confirmed

 

[Oldvatr]

Also worth noting that those original 149 were specially chosen too, <6 years T2 duration, BMI > 27, no insulin users.
Funnily enough that 7% success rate isn't far off the 5% observed by all T2s in the 2019 Scottish study.

https://pubmed.ncbi.nlm.nih.gov/34727107/

Only positive takeaway for Taylor is that the weight loss hypothesis appears to be confirmed

That is why until 2009 the NICE Guidelines always started their T2D roadmap for treatment with Step 1 = weight loss and lifestyle changes, before prescribing medication. Now NG 28 starts with immediate Metformin and additional SGLT2 if you have kidney problems. I note that in USA the SGLT2 is contraindicated if eGFR< 45 but in UK its free sweeties for everybody and beggar the consequences.

 

[Antje77]

The Taylor definition of remission is HbA1c below 48. and that is with or without meds.

In that case I must be in remission from T1, if it doesn't matter if you're on medication!

 

[Oldvatr]

In that case I must be in remission from T1, if it doesn't matter if you're on medication!

The original definition did not mention medication because the trial itself stopped all diabetic medications. I believe it now defines it as <48 and not using any T2D medication. Insulin users were excluded from the studies.

 

[Antje77]

The original definition did not mention medication because the trial itself stopped all diabetic medications. I believe it now defines it as <48 and not using any T2D medication. Insulin users were excluded from the studies.

Aw, too bad.