catherinecherub said:
Interesting. It doesn't seem to mention (unless I missed it) about how rigorously the patients actually stuck to the diet.
Perhaps only the '10 year success' patients actually stayed on the wagon. If they have a projected 15.4 years of 'normality' before needing insulin, then that seems a good enough reason to be pretty strict dietarily.
Some medical friends of mine say that almost all of their diabetic patients are quite obviously lying about their diet, in that the *say* they are eating and exercising sensibly, yet their weight either remains high or gets higher still - and obesity is known to favour the development of insulin resistance.
Similarly, the study makes no mention of exercise regime - again, exercise is known to reduce the impact of insulin resistance.
Finally, the authors assume in their projection (and the late stage for the 10year success people is *only* a projection) that once you hit a certain level of betacell loss, all patients will go into the same rapid decline NO MATTER HOW FAST OR IN WHAT MANNER they got to that point. It beggars belief that a morbidly obese sedentary person will decline at the same rate as an otherwise healthy active one.
So interesting, yes, but the paper is 7 years old and it would be interesting to see further supporting studies - suitably compensated for weight and exercise regimes.
I certainly don't see it as wholly worrying or negative, the prospect of staying normoglycemic for 15+ years through good adherence to dietary control (especially at my age coming up on 59) is pretty appealing - a lot of medical research can come tofruition in a decade and a half.
I would be very keen to see a further analysis of the original data - extended to cover the elapsed 7 years since publication to see just how accurate their projection was. Also important, would be to reanalyse the data against obesity and activity levels.
I tend toward optimism; immediately after diagnosis, I threw myself into exercise and dietary control and lost well over one third of my body weight to rapidly get my BMI back into the normal range. As a result, my fasting, postprandial and A1c measurements now fall into the normal range and I even pass an OGTT (at one and two hur points, since some studies suggest that the 1 hour may be a better predictive marker).
With the agreement of my gp, I've stopped medication, but I may talk about going back on low dose Glucobay next time I have an appointment. I found that if I used anything above a tiny dose of Metformin with meals, I tended to have a rebound effect causing my fasting to go up a little.
mark.
8) :roll:
