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Prof Roy Taylor hypothesis - DIRECT study & pancreatic fat

Bluetit1802 said:
I think that is about all it proves. I am very unhappy with the definition of remission, lack of information on the 54% that "failed", the relatively low numbers that "passed", and lack of information on the follow up diets.
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I think the point that is getting missed in quoting 46% “success” is that the “success” rate among those that lost 15kg or more was over 80% and therefore I would suppose that a lot of the “failures” to achieve remission as defined in the study were also those who “failed” at weight loss. More understanding of that diffeence would be very enlightening I think given that ALL diets from eat well to lchf to ND and all stations in between fail to achieve significant weight loss for a significant % of the population
 
The poster above has an extremely important point about the amount of weightloss and diabetes remission. Those who were studied, had a very big range in bmi, somebody with a bmi of 30 would probably respond more with a 15 kg weightloss, than somebody with a bmi of 40.

If you have a bmi of 40, would need to lose more weight, than you are able too under just 8 weeks.
 
I've been reading so much stuff on diabetes over the last year I may have got muddled up, but I'm a bit disappointed by this particular trial.

The first "Newcastle Experiment" was, I thought, very exciting, as 11/11 people became, and in some cases remained, non-diabetic by any normal medical measure. I had thought (have I got this wrong?) that in that experiment, OGTTs were used, and it was determined that the bodies of the participants had indeed changed quite dramatically in the way they responded to carbohydrates - they fell within the normal range, and, for example, the "first-phase" insulin response had started to work again.

Whereas in this latest experiment, the definition of "remission" has changed to be all about getting an HbA1c result of less than 6.5%.

But we know:

1) Two people can both get the same HbA1c result, yet one can be regularly getting dangerous spikes after carbohydrates while the other one is processing those same carbohydrates in a much more normal way.
2) Two people can both get the same HbA1c result, one through eating very few carbs, the other through eating a lot more carbs but having a body which is much better able to process carbs.

I think the OGTT is the most reliable indicator as to whether a certain process / experiment has changed a person's ability to process carbohydrates.

I'm tempted to pay for the Lancet item to read the whole thing, but has any one else read it, or found an article which mentions whether the participants had OGTTs, and how they changed?
 
AdamJames said:
Whereas in this latest experiment, the definition of "remission" has changed to be all about getting an HbA1c result of less than 6.5%.

But we know:

1) Two people can both get the same HbA1c result, yet one can be regularly getting dangerous spikes after carbohydrates while the other one is processing those same carbohydrates in a much more normal way.
2) Two people can both get the same HbA1c result, one through eating very few carbs, the other through eating a lot more carbs but having a body which is much better able to process carbs.

I think the OGTT is the most reliable indicator as to whether a certain process / experiment has changed a person's ability to process carbohydrates.
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The unreliability of the HbA1c (for several reasons) is my soapbox subject. Even making allowances for it's failures, to class remission as anything under 48 is ludicrous. I agree about the OGTT.
 
Well, good to know that as a 10 year T2 I am in remission.
However from my personal point of view that devalues the results as I know I am still T2 and managing my HbA1c through diet, exercise, and Metformin.

Hang on, I am not fully matching the results. However if I stopped Metformin for 2 months then I would apparently be fully in remission.

I think that it an enormously powerful message that weight loss and dietary control can give you pre-diabetic or better HbA1c. However remission is a different thing in my view.
 
Bluetit1802 said:
The unreliability of the HbA1c (for several reasons) is my soapbox subject. Even making allowances for it's failures, to class remission as anything under 48 is ludicrous. I agree about the OGTT.
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Yes, I gather that there are a great many reasons why an HbA1c result may not be the best indicator.

What I find frustrating is that even the OGTT has limitations and the results can be influenced in unclear ways.

It's known that it's best to have a normal carb intake in the day or two leading up to an NHS-style OGTT, so that your body is "ready to process carbs".

I've also found, in my experiments which I try to do as consistenly as possible, that there are factors which have an effect which I haven't worked out yet.

For example I do a 34 gram carbohydrate tolerance test in a very controlled way. I did one before I started to lose weight. After 3 stone lost, I repeated it and got a result which was just within non-diabetic range, so wondered if I'd gone into remission. But a few days later I repeated it again, and it was worse than the first one!

Some things I am trying: 1) What's the effect of eating a consistent amount of carbs in the days before the test, 2) What's the effect of eating a lot of fat the days before the test, and 3) What's the effect of doing more / less exercise the days before the test.

I'm pleased to say that I managed to get non-diabetic results again, after eating very little fat and doing plenty of exercise in the run up to the test. But I still haven't worked out the important factors. And I am in no doubt that in spite of it being possible to get this great result, I'm currently *managing* diabetes, I'm not in remission!
 
AdamJames said:
For example I do a 34 gram carbohydrate tolerance test in a very controlled way. I did one before I started to lose weight. After 3 stone lost, I repeated it and got a result which was just within non-diabetic range, so wondered if I'd gone into remission. But a few days later I repeated it again, and it was worse than the first one!
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Have you tried doing it with the 75g pure glucose drink, whereby there is no fibre, no protein and no fats to interfere with the results? You can buy the Rapilose pre-prepared drink that some doctors use, so no measuring required, and no noise from other food stuffs.
 
Bluetit1802 said:
Have you tried doing it with the 75g pure glucose drink, whereby there is no fibre, no protein and no fats to interfere with the results? You can buy the Rapilose pre-prepared drink that some doctors use, so no measuring required, and no noise from other food stuffs.
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I plan to do the 75g NHS-style glucose tolerance test if and when I start consistently passing my own 34g carb tolerance test. I'm careful to call mine a carb tolerance test rather than a glucose tolerance test as I'm expecting the pure glucose test to be a bigger challenge even though it's all glucose when it's in the blood.

In some ways it would have been nice to have done a full-on 75g glucose test before I lost weight, to compare results before and after, but to be honest at the time I had carb fear - I was getting dangerous and long-lasting spikes on as little as 6g of carbs from food that also had fibre in, so taking 75g of pure glucose just seemed like poisoning myself! So if/when I finally do it, I'll only be able to compare results to "normal" rather than "me a few months ago", but that will have to do!

Thanks for the tip re Rapilose, I hadn't heard of that.

Do you do this sort of test and what sort of things have you noticed?
 
I've just remembered another reason why didn't risk the 75g glucose tolerance test - because I'd read somewhere that the standard procedure stated that it should not be carried out if the starting bg was over a certain level. I can't find the source now but I think it was around 6 or 7 mmol/l. Either way, a few months ago, I couldn't get my fasting bg below 9.5 even after no carbs - I was in a very bad way then!
 
AdamJames said:
I plan to do the 75g NHS-style glucose tolerance test if and when I start consistently passing my own 34g carb tolerance test. I'm careful to call mine a carb tolerance test rather than a glucose tolerance test as I'm expecting the pure glucose test to be a bigger challenge even though it's all glucose when it's in the blood.

In some ways it would have been nice to have done a full-on 75g glucose test before I lost weight, to compare results before and after, but to be honest at the time I had carb fear - I was getting dangerous and long-lasting spikes on as little as 6g of carbs from food that also had fibre in, so taking 75g of pure glucose just seemed like poisoning myself! So if/when I finally do it, I'll only be able to compare results to "normal" rather than "me a few months ago", but that will have to do!

Thanks for the tip re Rapilose, I hadn't heard of that.

Do you do this sort of test and what sort of things have you noticed?
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AdamJames said:
I've just remembered another reason why didn't risk the 75g glucose tolerance test - because I'd read somewhere that the standard procedure stated that it should not be carried out if the starting bg was over a certain level. I can't find the source now but I think it was around 6 or 7 mmol/l. Either way, a few months ago, I couldn't get my fasting bg below 9.5 even after no carbs - I was in a very bad way then!
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This is the Rapilose
https://www.gpsupplies.com/rapilose-ogtt-glucose-solution-300ml-pack-of-1
http://penlanhealthcare.com/uploads/Rapilose-OGTT-Instructions-For-Use.pdf
http://penlanhealthcare.com/products-rapilose-ogtt-solution

A few of us on here have done a home OGTT. The hard part is having to eat 150g carbs for 3 days beforehand, although I didn't do this personally and of course it isn't compulsory, but to meet the WHO guidelines it should be done. I did mine and tested every 15 minutes from finishing the drink for 3 hours. The surprising thing I found was it kick started my pancreas and I saw amazing averages for several weeks afterwards, starting the same day I took the test.

You aren't quite right about about the standard procedure stating you should be starting above a certain level. The fasting test beforehand is simply to see if there is a second indication that you may be diabetic in addition to the 2 hour test. https://www.diabetes.co.uk/oral-glucose-tolerance-test.html

What should the OGTT results be?
People without diabetes
  • Fasting value (before test): under 6 mmol/L
  • At 2 hours: under 7.8 mmol/L
People with impaired glucose tolerance (IGT)
  • Fasting value (before test): 6.0 to 7.0 mmol/L
  • At 2 hours: 7.9 to 11.0 mmol/L
Diabetic levels
  • Fasting value (before test): over 7.0 mmol/L
  • At 2 hours: over 11.0 mmol/L

I apologise for going off topic on this interesting thread.
 
Thanks for all the info!

Bluetit1802 said:
You aren't quite right about about the standard procedure stating you should be starting above a certain level. The fasting test beforehand is simply to see if there is a second indication that you may be diabetic in addition to the 2 hour test.
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I wish I could find the source that I'd read at the time, but I've just spent 5 minutes and I can't, so I'm beginning to think I imagined it!

I don't think the guideline was about a fasting test, I got the impression it was more saying that if the bg level before the test is over a certain value, then it's risky to proceed, or no point in proceeding for some reason because it suggests the test might be invalid. If I ever find the source again I'll be sure to post it, but for now I'll assume I was hallucinating, thanks:)
 
AdamJames said:
Thanks for all the info!



I wish I could find the source that I'd read at the time, but I've just spent 5 minutes and I can't, so I'm beginning to think I imagined it!

I don't think the guideline was about a fasting test, I got the impression it was more saying that if the bg level before the test is over a certain value, then it's risky to proceed, or no point in proceeding for some reason because it suggests the test might be invalid. If I ever find the source again I'll be sure to post it, but for now I'll assume I was hallucinating, thanks:)
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There are guidelines about not proceeding if the glucose levels are high. Presumably so as not to send the person into orbit and possibly DKA. There are no guidelines for lower levels. The guidelines are set by WHO.
 
AdamJames said:
Thanks for all the info!



I wish I could find the source that I'd read at the time, but I've just spent 5 minutes and I can't, so I'm beginning to think I imagined it!

I don't think the guideline was about a fasting test, I got the impression it was more saying that if the bg level before the test is over a certain value, then it's risky to proceed, or no point in proceeding for some reason because it suggests the test might be invalid. If I ever find the source again I'll be sure to post it, but for now I'll assume I was hallucinating, thanks:)
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I have seen the same info, but like you I cannot recall where I saw it.

I also had a conversation with the nurse 5? years ago just before my last GTT in which she stated that if my bg was too high on a prick test, they would cancel the GTT. But I cannot remember what number = ‘too high’
 
Bluetit1802 said:
There are guidelines about not proceeding if the glucose levels are high. Presumably so as not to send the person into orbit and possibly DKA. There are no guidelines for lower levels. The guidelines are set by WHO.
Click to expand...

So I didn't imagine it? I'd love to know what the upper limit is, as I can't find a source now! I thought it was about 6 or 7 from memory and remember that whatever it was, I was quite a bit over it, hence me not wanting to do it.

Re no lower limit, I don't recall seeing one either, and I'm beginning to realise from your posts that I've given the impression I thought there was one! For the record I don't recall ever seeing one.
 
Brunneria said:
I have seen the same info, but like you I cannot recall where I saw it.

I also had a conversation with the nurse 5? years ago just before my last GTT in which she stated that if my bg was too high on a prick test, they would cancel the GTT. But I cannot remember what number = ‘too high’
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Thanks, it's nice to know I'm not imagining things, I really was starting to think I'd got the wrong end of the stick somewhere!

Finally, found *a* reference to it. I'm pretty sure it's not my original source, but still, this page says they are not recommended if fasting glucose is >= 7.1 mmol/l. (I was 9.5 at the time I was considering it):

https://www.sciencedirect.com/topics/neuroscience/glucose-tolerance-test
 
AdamJames said:
So I didn't imagine it? I'd love to know what the upper limit is, as I can't find a source now! I thought it was about 6 or 7 from memory and remember that whatever it was, I was quite a bit over it, hence me not wanting to do it.

Re no lower limit, I don't recall seeing one either, and I'm beginning to realise from your posts that I've given the impression I thought there was one! For the record I don't recall ever seeing one.
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I'm sure there must be an upper limit.. otherwise someone presenting with BG of say 25 mmol would be sent stratospheric by the test

http://penlanhealthcare.com/uploads/Rapilose-OGTT-Instructions-For-Use.pdf
There you go... should be less than 7 mmol/l
 
AdamJames said:
Thanks, it's nice to know I'm not imagining things, I really was starting to think I'd got the wrong end of the stick somewhere!

Finally, found *a* reference to it. I'm pretty sure it's not my original source, but still, this page says they are not recommended if fasting glucose is >= 7.1 mmol/l. (I was 9.5 at the time I was considering it):

https://www.sciencedirect.com/topics/neuroscience/glucose-tolerance-test
Click to expand...

Above 7mmol/l makes sense because the glucose raises BS levels by a considerable amount in the first hour or so before it starts to drop - and someone with above 7 fasting is likely to have high insulin resistance or low insulin production, so are likely to rise even higher than someone with more normal fasting levels, and this could be very dangerous for them. On my home test it was a very sharp spike, like a mountain peak. My peak was exactly on the hour.
 
AdamJames said:
I'm tempted to pay for the Lancet item to read the whole thing, but has any one else read it, or found an article which mentions whether the participants had OGTTs, and how they changed?
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Hi @AdamJames I have read the latest DiRECT research article. Before you pay for access to that, I would advise that you read the 'open access' study protocol published in 2016. It discusses the protocol used in the DiRECT study in fine detail (and, no, OGTT's were not part of the DiRECT protocol):
The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754868/pdf/12875_2016_Article_406.pdf
 
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