ND research - the view from ‘the other side’ ( as some see them)

woodywhippet61

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>But what does remission actually mean? It’s when blood glucose (or blood sugar) levels are in a normal range again.

>In this study, the team defined remission as having blood glucose levels (HbA1c) below 6.5% (48mmol/mol) after 12 months, with at least 2 months without any Type 2 diabetes medications.

Um is being below 48 mmol in the normal range? Doesn't pre-diabetes mean anything? I thought that normal range was below 42 mmol. Has the definition changed? Have the numbers gone up?

Actually looking at the site there is no mention of pre-diabetes at all. If it doesn't exist why did my gp diagnosed me with it 3 years ago?
 
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woodywhippet61

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Aaahh now I understand they don't agree with the definition.

>“Prediabetes isn’t actually a clinical term which is recognised by the World Health Organization. In fact, the American Diabetes Association has set the level for prediabetes at a blood glucose measurement of HbA1C 5.7% (39mmol/mol) but it is the only organisation which uses this criteria. In the UK there is no defined criteria for prediabetes or borderline diabetes.
 

ringi

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"pre-diabetes" mean GP tells you to keep to "eat well plate" and exercise more......... Therefore I think "remission" has been defined based on not needing any drugs diabetes.
 

Boo1979

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I think "remission" has been defined based on not needing any drugs diabetes.
Yes 12 months hba1c under 48 with at least the last 2 months of that period medication free.
I like that they are clear about the limitations of the study and the need for further research to address a number of questions
 

woodywhippet61

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Type of diabetes
Type 2
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"pre-diabetes" mean GP tells you to keep to "eat well plate" and exercise more......... Therefore I think "remission" has been defined based on not needing any drugs diabetes.

LOL Ringi that's what they tell you when you ARE diagnosed with Type 2. Well that's what they told me. My gp didn't tell me anything at all when they 'diagnosed' me with being pre-diabetic. It just wasn't that big a deal. Having read that it isn't a clinical term I now understand why it was 'no big deal' to my gp.

I think you are correct about the type 2's on meds. At the end of the day they are the ones who are costing the NHS money.
 

Biggles2

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But what does remission actually mean? It’s when blood glucose (or blood sugar) levels are in a normal range again.

The best resource that I have found is the 2009 position paper by Buse et al:

How Do We Define Cure of Diabetes?

“A remission can be characterized as partial or complete.
Partial remission
is sub-diabetic hyperglycemia (A1C not diagnostic of diabetes [<6.5%], fasting glucose 100–125 mg/dl [5.6–6.9 mmol/l]) of at least 1 year's duration in the absence of active pharmacologic therapy or ongoing procedures.

Complete remission is a return to “normal” measures of glucose metabolism (A1C in the normal range, fasting glucose <100 mg/dl [5.6 mmol/l]) of at least 1 year's duration in the absence of active pharmacologic therapy or ongoing procedures.”​

http://care.diabetesjournals.org/content/32/11/2133
 

AdamJames

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I like that they are clear about the limitations of the study and the need for further research to address a number of questions

Me too. The biggest one being that they aren't even saying it will reduce complications; they are saying that they want to find out if it will reduce complications in the long term.
 

woodywhippet61

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489
Type of diabetes
Type 2
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Diet only
The best resource that I have found is the 2009 position paper by Buse et al:

How Do We Define Cure of Diabetes?

“A remission can be characterized as partial or complete.
Partial remission
is sub-diabetic hyperglycemia (A1C not diagnostic of diabetes [<6.5%], fasting glucose 100–125 mg/dl [5.6–6.9 mmol/l]) of at least 1 year's duration in the absence of active pharmacologic therapy or ongoing procedures.

Complete remission is a return to “normal” measures of glucose metabolism (A1C in the normal range, fasting glucose <100 mg/dl [5.6 mmol/l]) of at least 1 year's duration in the absence of active pharmacologic therapy or ongoing procedures.”​

http://care.diabetesjournals.org/content/32/11/2133

that isn't me asking it's a direct quote from diabetes.org However thank you for the definition
 

Bluetit1802

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Aaahh now I understand they don't agree with the definition.

>“Prediabetes isn’t actually a clinical term which is recognised by the World Health Organization. In fact, the American Diabetes Association has set the level for prediabetes at a blood glucose measurement of HbA1C 5.7% (39mmol/mol) but it is the only organisation which uses this criteria. In the UK there is no defined criteria for prediabetes or borderline diabetes.

Errrrr so what are the folk that fall between 41 and 47?

I just checked my lab reports for the standard for non-diabetic.
Up to December 2015, normal was 20 to 42.
From July 2016 normal has been 20 to 41.

Logically, therefore, 42 and upwards is not normal.
 

ringi

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To make it even more complex VirtaHealth defines remission to include people who are taking Metformin, as Metformin is seen in the USA as a way to prevent Type2.

(As Metformin has so many benefits other than reducing BG, I intend to remain taking it as long as it does not affect my quality of life, however, low my AC1 gets.)
 

woodywhippet61

Well-Known Member
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489
Type of diabetes
Type 2
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Diet only
Errrrr so what are the folk that fall between 41 and 47?

I just checked my lab reports for the standard for non-diabetic.
Up to December 2015, normal was 20 to 42.
From July 2016 normal has been 20 to 41.

Logically, therefore, 42 and upwards is not normal.

Maybe it's because traditionally pre-diabetics could stop becoming type 2 with lifestyle changes rather than being type 2 and being it for ever. Oops nope that doesn't really work does it given that I've been told that I am not considered diabetic by my surgery so what is the difference for me between being pre-diabetic and type 2 as diagnosed by my surgery. There's no logic to that either.

Also I made a bargain so that I wouldn't be on meds. So I'd have been on them if I hadn't objected and my original A1c test results put me well within the type 2 range. Yet I'm not any longer.
 

Bluetit1802

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Type of diabetes
Type 2 (in remission!)
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Maybe it's because traditionally pre-diabetics could stop becoming type 2 with lifestyle changes rather than being type 2 and being it for ever. Oops nope that doesn't really work does it given that I've been told that I am not considered diabetic by my surgery so what is the difference for me between being pre-diabetic and type 2 as diagnosed by my surgery. There's no logic to that either.

Also I made a bargain so that I wouldn't be on meds. So I'd have been on them if I hadn't objected and my original A1c test results put me well within the type 2 range. Yet I'm not any longer.


It's all crackers. Until I see the actual HbA1c levels of the 46% after 12 months, and the results of their liver scans/insulin resistance tests, and details of their "normal" diet, I will continue to be sceptical.

I am pleased to see that extra money has been made available for the study to continue for a longer period.
 
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ringi

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But why can't they do a study on "low carb" and compare the results?

I expect the long-term results will be a lot better for "low carb" if a reduction in AC1 levels without increased drugs was considered as an outcome and everyone at the given GPs were included not just the people who agreed to do the diet.

(I don't know how many people declined to take part in this ND study as they did not want to do the diet, or were removed from the study for not keeping to the shakes.)
 

woodywhippet61

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489
Type of diabetes
Type 2
Treatment type
Diet only
But why can't they do a study on "low carb" and compare the results?

I expect the long-term results will be a lot better for "low carb" if a reduction in AC1 levels without increased drugs was considered as an outcome and everyone at the given GPs were included not just the people who agreed to do the diet.

(I don't know how many people declined to take part in this ND study as they did not want to do the diet, or were removed from the study for not keeping to the shakes.)

Surely the reason that they won't compare low carb and ND is that once remission is achieved there is a 'return' to structured and supported 'normal healthy' eating i.e. eating carbs. It seems to me 'remission' is all about being able to eat carbs again without having type 2 levels of glucose.
 

Boo1979

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I think you are correct about the type 2's on meds. At the end of the day they are the ones who are costing the NHS money.
Speaking as one of those who’s diabetes is at a severe enough level to require meds in addition to dietary and other interventions in order to keep BMs at a reasonable level, Im really unsure what the **** you intend to mean by that comment
 
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Boo1979

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1,849
Type of diabetes
Other
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Tablets (oral)
But why can't they do a study on "low carb" and compare the results?

I expect the long-term results will be a lot better for "low carb" if a reduction in AC1 levels without increased drugs was considered as an outcome and everyone at the given GPs were included not just the people who agreed to do the diet.

(I don't know how many people declined to take part in this ND study as they did not want to do the diet, or were removed from the study for not keeping to the shakes.)
1)Because the hypothesis under consideration had nothing to do with low carb. How / if different diets effect things is a secondary or tertiary research target
2) because they are studying a short term intervention designed to produce remission in and exclusively limited to, T2 whereas low carb is a long term dietery change predominantly focused on managing diabetes, mainly but not exclusively T2
 
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AdamJames

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Type 2
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LOL Ringi that's what they tell you when you ARE diagnosed with Type 2. Well that's what they told me. My gp didn't tell me anything at all when they 'diagnosed' me with being pre-diabetic. It just wasn't that big a deal. Having read that it isn't a clinical term I now understand why it was 'no big deal' to my gp.

I think you are correct about the type 2's on meds. At the end of the day they are the ones who are costing the NHS money.

Speaking as one of those who’s diabetes is at a severe enough level to require meds in addition to dietary and other interventions in order to keep BMs at a reasonable level, Im really unsure what the **** you intend to mean by that comment

One certainly does need to be careful of one's thought processes and wording. I keep meaning to write an essay on "Diabetes and Blame" and post it to the soap box forum:)

First of all, as an overweight Type 2 myself, and having lost 3 stone in 3 months and trying to avoid medication, does that make me "okay" in terms of not being a burden to society? That's quite simplistic. If I'd just accepted the metformin, which costs about £30 a year, I'd probably be more certain to avoid complications in the future which cost a lot of money to deal with.

It's also simplistic to assume that Type 2 is self-induced. And even for those who would not have been Type 2 had they eaten more sensibly and exercised more, what do we know about their background? About their parenting, nutritional advice, their happiness levels, there ability to become addicted to food compared to the average person, the behaviour of their metabolic system compared to the average even before they became Type 2.

Anyway, one really does need to be careful about comments and thought processes I think. A lot of people on this forum will be facing real quality of life issues and the last thing they need is to feel guilt on top of all that.
 
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Boo1979

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Errrrr so what are the folk that fall between 41 and 47?

I just checked my lab reports for the standard for non-diabetic.
Up to December 2015, normal was 20 to 42.
From July 2016 normal has been 20 to 41.

Logically, therefore, 42 and upwards is not normal.
Diabetes is a universally agreed disease state wheres pre diabetes is a term reflecting increased risk of developing that disease state
As with everything medical there is in reality no absolute number in a blood test that says “ patient x has y disease and will therefore develop symptoms a,b,c, and d” so a somewhat arbitrary line has to be drawn as a cutoff between a disease and non disease states. These are based on percentile risk and the disease cutoff point is where the risk % reaches a high enough level,
 
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