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New study

From the article

In the US, approximately 10% of people with prediabetes progress to having diabetes each year.

Intensive lifestyle modification, consisting of calorie restriction, increased physical activity (≥150 min/wk), self-monitoring, and motivational support, decreased the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period. Metformin decreased the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years.


So 6 out of 33 people with lifestyle modification didn't get diabetes over 3 years, while metformin decreased the number by 3 ? And without any intervention about 11 of the 33 would progress to diabetes?

Have I misunderstood the terminology?
 
EllieM said:
From the article

In the US, approximately 10% of people with prediabetes progress to having diabetes each year.

Intensive lifestyle modification, consisting of calorie restriction, increased physical activity (≥150 min/wk), self-monitoring, and motivational support, decreased the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period. Metformin decreased the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years.


So 6 out of 33 people with lifestyle modification didn't get diabetes over 3 years, while metformin decreased the number by 3 ? And without any intervention about 11 of the 33 would progress to diabetes?

Have I misunderstood the terminology?
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My take away is that lifestyle changes are better than metformin.
 
OrsonKartt said:
My take away is that lifestyle changes are better than metformin.
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Ever since I was DX'ed over 30 years ago, the NICE Guideloines step 1 (pre medication) had always been lifestyle and diet changes. so nothing new in the message. Pity they only explored CICO diets.

I note that NG 28 has been changed [2009] to remove the lifestyle and diet step, and it now goes straight to drug therapy. Metformin for all, and if you have kidney weakness then SGLT2 as step 1.
 
Oldvatr said:
Ever since I was DX'ed over 30 years ago, the NICE Guideloines step 1 (pre medication) had always been lifestyle and diet changes. so nothing new in the message. Pity they only explored CICO diets.

I note that NG 28 has been changed [2009] to remove the lifestyle and diet step, and it now goes straight to drug therapy. Metformin for all, and if you have kidney weakness then SGLT2 as step 1.
Click to expand...

I was offered it 6 yrs ago on dx and refused it going down the lifestyle path . I’ve been low carb / keto since. Recently ( last year or so ) my fasting levels are slightly higher. I tried 500 mg of metformin daily for 4 months with zero impact - slight increase in hba1c - which of course could be coincidental. I’ve now stopped and after a decent flush period , maybe a month will try newer things.

There’s a lot of talk about reversing this disease. In my experience this may be a bit of an exaggeration. I do however still very much enjoy and embrace a keto life style
 
Semantics. I am usually very careful with words. Diabetes is never reversible - it's an illness for life, so we might as well make a friend of it. But it is possible for us T2s to have it well controlled. Or we might get away with calling it in remission even though it hasn't gone anywhere. If we push our boundaries with food, we can find our individual limitations, but we will never be non-diabetic even if we manage to keep our levels in the non-diabetic range. It's okay. It's very manageable, whether with diet or (for some of us) help from medication. Many illnesses don't offer those options.
 
OrsonKartt said:
You may well be right about about type 2 being progressive, this despite all the lovely words about reversing it
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8 years ago I had progressed to the insulin stage, and then I found this site. If going from an HbA1c of 106 when maxed out on 3 oral meds down to 7 years at least of sub 48 (not diabetic) levels is not reversal, then I will eat my hat. I am in control, and no sign of progression yet. LCHF was my savoiur, and I am still not on insulin therapy.
 
OrsonKartt said:
Life style intervention better than metformin in pre diabetic diagnosis. https://jamanetwork.com/journals/jama/article-abstract/2803510?utm_source=substack&utm_medium=email
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Thanks for the link. The real tragedy is that there is so much that can be done both to prevent and to moderate the effects of T2 diabetes, and yet the health service is still (in the main) sticking with its less effective methods.

Bilous and Donnelly describe diabetes as the most common cause of blindness in those of working age, the most common cause of renal failure worldwide, and the most common cause of non-traumatic lower limb amputation. Mortality from heart disease and stroke is 2 to 4 times higher compared to a similar non-diabetic population. It really doesn't have to be that way. It is controllable and the outcomes above can be avoided.
 
Certainly agree with Kenny, but i feel all the effort should start as soon as a prediabetic reading is seen. That is the time to bash it on head, when the most good can be done. Maybe even earlier by proper screening, to show signs of the start of Insulin resistance.
 
ajbod said:
Certainly agree with Kenny, but i feel all the effort should start as soon as a prediabetic reading is seen. That is the time to bash it on head, when the most good can be done. Maybe even earlier by proper screening, to show signs of the start of Insulin resistance.
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Not so easy. I periodically offer my children a test in case it is genetic. They are not interested. My son looks like he is beginning to suffer METS (Metabolic Syndrome) since he has quite a paunch now. He assures me it is a beer belly, and seeing he drinks like a fish, I cannot disagree. I am trying to wean him onto whisky and less beer but its a losing battle.gftrrrrrrrrrr45r (cat typing a response - edited in line with Forum ethos)
 
Oldvatr said:
Not so easy. I periodically offer my children a test in case it is genetic. They are not interested. My son looks like he is beginning to suffer METS (Metabolic Syndrome) since he has quite a paunch now. He assures me it is a beer belly, and seeing he drinks like a fish, I cannot disagree. I am trying to wean him onto whisky and less beer but its a losing battle.gftrrrrrrrrrr45r (cat typing a response - edited in line with Forum ethos)
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It’s not the cheapest of beers but it is genuinely carb free and I’ve tested while wearing a libre is : https://www.sugarfreebeer.com. It tastes pretty darn good too
 
OrsonKartt said:
It’s not the cheapest of beers but it is genuinely carb free and I’ve tested while wearing a libre is : https://www.sugarfreebeer.com. It tastes pretty darn good too
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expensive water with an alcohol additive? I have just watched a TV ad for a carb free beer, and I thought at the time what;s the point? It goes down the same drain. So does the money it seems. At least the Italian one has alcohol, which the one on TV did not, But it is just a chemical mixture, bit like Fanta used to be. (during WW2 Germany could not make coca cola, so they invented an orange fizzy using beetroot and whey and other waste prducts so truly Erzatz since it never saw an orange in its life)
 
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OrsonKartt said:
My take away is that lifestyle changes are better than metformin.
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Seems so. We know Metfartin does little for the diabetes anyway. I do wonder what the rate looks like at 6 years. calorie restricted diets are not generally well tolerated in the long run. intense exercise levels also wane with the years. Will they still progress to insulin eventually?
 
Oldvatr said:
Seems so. We know Metfartin does little for the diabetes anyway. I do wonder what the rate looks like at 6 years. calorie restricted diets are not generally well tolerated in the long run. intense exercise levels also wane with the years. Will they still progress to insulin eventually?
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Well plenty of us in here to track it? :) Over time.
 
Oldvatr said:
expensive water with an alcohol additive? I have just watched a TV ad for a carb free beer, and I thought at the time what;s the point? It goes down the same drain. So does the money it seems. At least the Italian one has alcohol, which the one on TV did not, But it is just a chemical mixture, bit like Fanta used to be. (during WW2 Germany could not make coca cola, so they invented an orange fizzy using beetroot and whey and other waste prducts so truly Erzatz since it never saw an orange in its life)
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Once upon a time I was a regular beer drinker. I brewed my own. After 5 years of not touching a drop I was surprised at the hoppy flavour of the Italian sugar free beer. I’m guessing they have developed / discovered a yeast which can convert the sugars into alcohol without dying.
 
OrsonKartt said:
Once upon a time I was a regular beer drinker. I brewed my own. After 5 years of not touching a drop I was surprised at the hoppy flavour of the Italian sugar free beer. I’m guessing they have developed / discovered a yeast which can convert the sugars into alcohol without dying.
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I'm a fan of the Salute beers - the best zero carb I have tried. I have no idea how they get to zero sugar, but they claim the beers to be "brewed by artisan beer makers in Treviso" which if true rules out the ersatz option - if untrue their advertising seems not to comply with the law. It also has the "artigianale" appellation which you can't use in Italy unless your product is traditionally made.
 
KennyA said:
I'm a fan of the Salute beers - the best zero carb I have tried. I have no idea how they get to zero sugar, but they claim the beers to be "brewed by artisan beer makers in Treviso" which if true rules out the ersatz option - if untrue their advertising seems not to comply with the law. It also has the "artigianale" appellation which you can't use in Italy unless your product is traditionally made.
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Could still apply if the alcohol component is created naturally, but I take your point. seems to be a useful if expensive solution but its a problem I no longer have. I used to down 6 to 8 pints of Newcastle Brown Ale (Newkey Pukey) in a night and finish off with chips and custard from the local chippie. Possibly the reason why I am posting on this site?
 
Oldvatr said:
Could still apply if the alcohol component is created naturally, but I take your point. seems to be a useful if expensive solution but its a problem I no longer have. I used to down 6 to 8 pints of Newcastle Brown Ale (Newkey Pukey) in a night and finish off with chips and custard from the local chippie. Possibly the reason why I am posting on this site?
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Snap, although in my case it tended to be Guinness and chips with curry sauce. All roads eventually lead to Rome.
 
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