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Article recognises T2 can be reversed by lifestyle

Alexandra100 said:
https://www.medscape.com/viewarticle/920698?src=wnl_edit_tpal&uac=189923FN&impID=2154803&faf=1#vp_2

“Discusses taking patients off meds when they have lowered their A1cs by lifestyle changes.
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.”.. he believes, will eventually require the development of an algorithm for de-escalating therapy, but thinks that is "a few years away".”

The algorithm approach is something I wrote about in a thread some weeks back. Good to hear it might actually be taking root.
 
Surely this is a matter of art and not mathematical science? Dr Sarah McCorrmack runs a low carb t2 programme and advises halving doses of hypoglycemic agents and anti hypertensives when adopting a very low carb diet.
Then titrate to the individual's response or am I missing something?
 
NicoleC1971 said:
Surely this is a matter of art and not mathematical science? Dr Sarah McCorrmack runs a low carb t2 programme and advises halving doses of hypoglycemic agents and anti hypertensives when adopting a very low carb diet.
Then titrate to the individual's response or am I missing something?
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It doesn’t seem you’re missing anything to me. I think there’s a variety of responses to the need to stop medications because until recently it just didn’t happen often enough that national guidelines were required. Perhaps what these articles do is highlight that remission is happening and people are coming off medications despite long held ignorance that it’s possible!!
 
NicoleC1971 said:
Surely this is a matter of art and not mathematical science? Dr Sarah McCorrmack runs a low carb t2 programme and advises halving doses of hypoglycemic agents and anti hypertensives when adopting a very low carb diet.
Then titrate to the individual's response or am I missing something?
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I don't think you are missing anything except possibly the profit margin made by the person selling the app with the unnecessary wonderful algorithm?
 
HSSS said:
There was also this earlier this year
https://bjgp.org/content/69/684/360
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This article defines a low carb diet as 130g net carbs daily. I do wonder how many people can achieve "remission" while eating so many carbs. If I remember correctly, the original Medscape article cited an A1c of 48 as normal and justifying suppression of meds.
 
HSSS said:
It doesn’t seem you’re missing anything to me. I think there’s a variety of responses to the need to stop medications because until recently it just didn’t happen often enough that national guidelines were required. Perhaps what these articles do is highlight that remission is happening and people are coming off medications despite long held ignorance that it’s possible!!
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A clever algorithm with a trained GP to run it, might do it though.
 
Alexandra100 said:
This article defines a low carb diet as 130g net carbs daily. I do wonder how many people can achieve "remission" while eating so many carbs. If I remember correctly, the original Medscape article cited an A1c of 48 as normal and justifying suppression of meds.
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It actually sounds less than 130g is classed as low carb. Not an unusual definition.

A few in here do seem to manage on these sort of levels, I certainly am not one of them.

The linked article doesn’t mention remission or even normal nor what justifies suppression. Just:-
When deciding the safety and appropriateness of T2D medications with an LCD there are three key clinical considerations: Is there a risk of the drug causing hypoglycaemia or other adverse event?; What is the degree of carbohydrate restriction?; Once carbohydrate is reduced does the drug continue to provide health benefit, and if so are the potential drug benefits greater than or less than possible risks and side effects?​
I’m not sure what you are referring to.
 
Listlad said:
A clever algorithm with a trained GP to run it, might do it though.
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Or just some simple written guidelines and principles acknowledging suppression is a genuinely needed occurrence that any gp can follow would probably do the job. Don’t see the need for clever algorithms or special training but what do I know I’m not a gp!
 
Alexandra100 said:
This article defines a low carb diet as 130g net carbs daily. I do wonder how many people can achieve "remission" while eating so many carbs. If I remember correctly, the original Medscape article cited an A1c of 48 as normal and justifying suppression of meds.
Click to expand...
My last two HbA1c results were 35 and 36 respectively, on those levels (max).
 
HSSS said:
Or just some simple written guidelines and principles acknowledging suppression is a genuinely needed occurrence that any gp can follow would probably do the job. Don’t see the need for clever algorithms or special training but what do I know I’m not a gp!
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They work in complex situations in other fields.
 
HSSS said:
I’m not sure what you are referring to.
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This is the quote from the Medscape article I was remembering, but I see that it refers mostly to discontinuing eg statins, though by implication it also refers to diabetes meds:

"Another member of the audience asked, if Dr Rabbani's practice is using the NICE guidelines in reverse, what would they do with a patient who is on the threshold for stopping a drug.
He explained that, if a patient has an HbA1c level of 48 mmol/mol, would they not then be at risk of seeing their blood glucose level going a lot higher if their drug treatment were stopped? Consequently, should a lower threshold be used?
Dr Rabbani replied that the answer is that "you have to look at the patient as a whole", particularly in terms of their other, non-diabetes medications, such as statins.
However, if a patient had got to that HbA1c level by losing a lot of weight and "feels a lot healthier", then their doctor should also consider reducing their antihypertensive and anti-cholesterol medications.
"It's actually quite complex, because all these symptoms are interlinked and the underlying cause is the same."

Btw, my understanding is that hypertension may be symptomless, so stopping those meds just because the patient "feels a lot healthier" might not be the best idea. I hear that GPs spend a lot of time and energy trying to convince patients who feel heaalthy that their bg and bp are too high.
 
Alexandra100 said:
This article defines a low carb diet as 130g net carbs daily. I do wonder how many people can achieve "remission" while eating so many carbs. If I remember correctly, the original Medscape article cited an A1c of 48 as normal and justifying suppression of meds.
Click to expand...
@Alexandra100 it is possible - I have maintained non diabetic levels for 6 years on an average of between 100g to 130g carbs per day. I believe @Listlad has a similar carb intake and is managing to maintain a non diabetic hba1c.
 
Alexandra100 said:
This is the quote from the Medscape article I was remembering, but I see that it refers mostly to discontinuing eg statins, though by implication it also refers to diabetes meds:

"Another member of the audience asked, if Dr Rabbani's practice is using the NICE guidelines in reverse, what would they do with a patient who is on the threshold for stopping a drug.
He explained that, if a patient has an HbA1c level of 48 mmol/mol, would they not then be at risk of seeing their blood glucose level going a lot higher if their drug treatment were stopped? Consequently, should a lower threshold be used?
Dr Rabbani replied that the answer is that "you have to look at the patient as a whole", particularly in terms of their other, non-diabetes medications, such as statins.
However, if a patient had got to that HbA1c level by losing a lot of weight and "feels a lot healthier", then their doctor should also consider reducing their antihypertensive and anti-cholesterol medications.
"It's actually quite complex, because all these symptoms are interlinked and the underlying cause is the same."

Btw, my understanding is that hypertension may be symptomless, so stopping those meds just because the patient "feels a lot healthier" might not be the best idea. I hear that GPs spend a lot of time and energy trying to convince patients who feel heaalthy that their bg and bp are too high.
Click to expand...
My hba1c rose from 48 at diagnosis to 54 within 3 months of starting statins. It soon dropped after coming off them due to other side effects so for me I had to come off them to drop my BS.
 
Alexandra100 said:
This is the quote from the Medscape article I was remembering, but I see that it refers mostly to discontinuing eg statins, though by implication it also refers to diabetes meds:

"Another member of the audience asked, if Dr Rabbani's practice is using the NICE guidelines in reverse, what would they do with a patient who is on the threshold for stopping a drug.
He explained that, if a patient has an HbA1c level of 48 mmol/mol, would they not then be at risk of seeing their blood glucose level going a lot higher if their drug treatment were stopped? Consequently, should a lower threshold be used?
Dr Rabbani replied that the answer is that "you have to look at the patient as a whole", particularly in terms of their other, non-diabetes medications, such as statins.
However, if a patient had got to that HbA1c level by losing a lot of weight and "feels a lot healthier", then their doctor should also consider reducing their antihypertensive and anti-cholesterol medications.
"It's actually quite complex, because all these symptoms are interlinked and the underlying cause is the same."

Btw, my understanding is that hypertension may be symptomless, so stopping those meds just because the patient "feels a lot healthier" might not be the best idea. I hear that GPs spend a lot of time and energy trying to convince patients who feel heaalthy that their bg and bp are too high.
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aha I’m with you now. Sorry, I thought you were referring to my link not the post#1 link. I think the quotes in your post 13 and mine in post 11 answer your point though. Look at the whole picture not just an isolated score whatever it’s numerical value.
 
Alexandra100 said:
This article defines a low carb diet as 130g net carbs daily. I do wonder how many people can achieve "remission" while eating so many carbs. If I remember correctly, the original Medscape article cited an A1c of 48 as normal and justifying suppression of meds.
Click to expand...

Personally I don't see 130 carbs as 'eating so many'. Relatively speaking to the average it IS low carb as this very site says too.
 
KK123 said:
Personally I don't see 130 carbs as 'eating so many'. Relatively speaking to the average it IS low carb as this very site says too.
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All very true. But to those of us eating down at the sub 50g, or even those sub 20g levels, it sounds a lot. I guess it all is a matter of perspective.
 
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