Reversal or remission - your thoughts

[Dark Horse]

The British GPs will use the term "Resolved", and one kind community member photographed their medical file and uploaded it to the forum for us to see the use of this term.

I have no doubt however that should we revert to type, the said resolved status will be but like a vapour


Diagnosed 13 April 16: T2, no meds, HbA1c 53, FBG 12.6, Trigs 3.6, HDL .75, LDL 4.0, BP 169/95, weight 13st 8lbs, (2012 - 17st 7lbs, waist 42") waist 34".

2 June 16: FBG AV 4.6, Trigs 1.5, HDL 2.0, LDL 3.0, BP 120/72, weight 11st 11lbs, (2012 - 17st 7lbs, waist 42") waist 30".

Never give in, never give in, never never never given in...Winston Churchill.

Sent from my iPhone3 June16:

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If a GP is using the term "resolved" they are ignoring the guidance from PHE:-

"Current evidence shows that all people with diabetes should be screened for diabetic retinopathy for life once there has been a definite diagnosis of diabetes, excluding gestational diabetes. New GP Read codes were introduced in 2014 to take this guidance into account.

Before 2014, many GPs used the code ‘Diabetes resolved’ for patients whose blood sugar levels normalised following treatment, such as pancreatic transplant, or intensive weight reduction. These patients were then removed from the register of people requiring annual retinal screening – even though their risk of developing diabetic retinopathy may have increased following a rapid improvement in diabetes control.

Such patients should now be classified as ‘Diabetes in remission’. This ensures they are still invited for screening.

GPs should therefore review all patients with a ‘Diabetes resolved’ Read code and amend to ‘Diabetes in remission’ as appropriate. Local diabetic eye screening programmes should review their registers to ensure that patients who should be recalled for screening are not marked as ‘no longer diabetic’ in their screening programme software systems.

Recent local programme audits have identified several patients incorrectly categorised in this way. The risk may be higher for programmes where older versions of DES software did not have suitable selection options to categorise patients.

One local audit found that 4-5% of patients who had been suspended from screening due to the category of ‘never had diabetes’ and ‘no longer diabetic’ did have diabetes and should have been invited for screening. It also found 5 patients who were not being recalled for screening because of the way they were labelled in the software after undergoing successful transplants."

Source:-https://phescreening.blog.gov.uk/2016/05/23/audits-can-ensure-patients-dont-slip-through-diabetic-eye-screening-net/

 

[Dan01]

Just read this thread and was surprised by all the negativity in the beginning about "T2 being for life not just Christmas"; well I have to disagree! I cured/reversed/am in remission by following a very low calorie diet and then low carb. Within 3 months from diagnosis I had reduced a very high HbA1c to normal levels and had returned my fasting levels to normal. My HbA1c is now consistently in the low 30s and I eat whatever I like and that includes pizza, chips, liquorice without any ill effects.

So don't accept the NHS progressive stance. It may be true for some but not all. Whatever happens take control as best you can and live life.

I agree - my GP has informed me that I was diet / exercise controlled (no meds etc.) and my last four HbA1c readings are all normal, having lost 5 stone in weight, I am no longer classes as diabetic.

 

[KevinPotts]

If a GP is using the term "resolved" they are ignoring the guidance from PHE:-

"Current evidence shows that all people with diabetes should be screened for diabetic retinopathy for life once there has been a definite diagnosis of diabetes, excluding gestational diabetes. New GP Read codes were introduced in 2014 to take this guidance into account.

Before 2014, many GPs used the code ‘Diabetes resolved’ for patients whose blood sugar levels normalised following treatment, such as pancreatic transplant, or intensive weight reduction. These patients were then removed from the register of people requiring annual retinal screening – even though their risk of developing diabetic retinopathy may have increased following a rapid improvement in diabetes control.

Such patients should now be classified as ‘Diabetes in remission’. This ensures they are still invited for screening.

GPs should therefore review all patients with a ‘Diabetes resolved’ Read code and amend to ‘Diabetes in remission’ as appropriate. Local diabetic eye screening programmes should review their registers to ensure that patients who should be recalled for screening are not marked as ‘no longer diabetic’ in their screening programme software systems.

Recent local programme audits have identified several patients incorrectly categorised in this way. The risk may be higher for programmes where older versions of DES software did not have suitable selection options to categorise patients.

One local audit found that 4-5% of patients who had been suspended from screening due to the category of ‘never had diabetes’ and ‘no longer diabetic’ did have diabetes and should have been invited for screening. It also found 5 patients who were not being recalled for screening because of the way they were labelled in the software after undergoing successful transplants."

Source:-https://phescreening.blog.gov.uk/2016/05/23/audits-can-ensure-patients-dont-slip-through-diabetic-eye-screening-net/

What a fascinating insight Thanks!


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[Dark Horse]

What a fascinating insight Thanks!


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You're welcome. I have to say I always love your enthusiasm !

 

[JohnEGreen]

My GP's last words to me during my last appointment with him were and I quote "Thats great now ****** off"

 

[AndBreathe]

If a GP is using the term "resolved" they are ignoring the guidance from PHE:-

"Current evidence shows that all people with diabetes should be screened for diabetic retinopathy for life once there has been a definite diagnosis of diabetes, excluding gestational diabetes. New GP Read codes were introduced in 2014 to take this guidance into account.

Before 2014, many GPs used the code ‘Diabetes resolved’ for patients whose blood sugar levels normalised following treatment, such as pancreatic transplant, or intensive weight reduction. These patients were then removed from the register of people requiring annual retinal screening – even though their risk of developing diabetic retinopathy may have increased following a rapid improvement in diabetes control.

Such patients should now be classified as ‘Diabetes in remission’. This ensures they are still invited for screening.

GPs should therefore review all patients with a ‘Diabetes resolved’ Read code and amend to ‘Diabetes in remission’ as appropriate. Local diabetic eye screening programmes should review their registers to ensure that patients who should be recalled for screening are not marked as ‘no longer diabetic’ in their screening programme software systems.

Recent local programme audits have identified several patients incorrectly categorised in this way. The risk may be higher for programmes where older versions of DES software did not have suitable selection options to categorise patients.

One local audit found that 4-5% of patients who had been suspended from screening due to the category of ‘never had diabetes’ and ‘no longer diabetic’ did have diabetes and should have been invited for screening. It also found 5 patients who were not being recalled for screening because of the way they were labelled in the software after undergoing successful transplants."

Source:-https://phescreening.blog.gov.uk/2016/05/23/audits-can-ensure-patients-dont-slip-through-diabetic-eye-screening-net/

I believe the patient Kevin referred to may have been me. The following Windows snips are are lifted from my SystemsOnline records. Please note the relevant dates:

I can't find the entry with my latest retinopathy result in it, but I'm delighted to confirm it was the same as the others; no retinopathy.

So, I have had 2 retinopathy screenings since being declared Resolved by my GP, so it seems my practise are operating within current guidelines, unless I am mistaken. I am told, and I agree, that once diagnosed, then resolved, I will remain a higher risk than the general population of recrossing the line. I'm making it my business to do what I can to prevent that from happening.

I'll continue to have my screening as and when appropriate, although the blood panels are due to be annual. The interim results, in my signature, last year, were due to some non-diabetes related surgery I underwent. I was offered an HbA1c, and took the opportunity to see where I officially was as the period leading up to the slicing and dicing had been somewhat stressful.

Edit, just to add the blue blobs are to cover the HCP's name.

 

[Dark Horse]

I believe the patient Kevin referred to may have been me. The following Windows snips are are lifted from my SystemsOnline records. Please note the relevant dates:

View attachment 19823

View attachment 19824

View attachment 19825

I can't find the entry with my latest retinopathy result in it, but I'm delighted to confirm it was the same as the others; no retinopathy.

So, I have had 2 retinopathy screenings since being declared Resolved by my GP, so it seems my practise are operating within current guidelines, unless I am mistaken. I am told, and I agree, that once diagnosed, then resolved, I will remain a higher risk than the general population of recrossing the line. I'm making it my business to do what I can to prevent that from happening.

I'll continue to have my screening as and when appropriate, although the blood panels are due to be annual. The interim results, in my signature, last year, were due to some non-diabetes related surgery I underwent. I was offered an HbA1c, and took the opportunity to see where I officially was as the period leading up to the slicing and dicing had been somewhat stressful.

Edit, just to add the blue blobs are to cover the HCP's name.

Interesting, thank you. It's good that you are still getting your retinal screening despite the "diabetes resolved" code. I wonder if your GP is using different software.

It's a shame that there is still this confusion over terminology when PHE have tried to clear it up. The bottom line is that anybody who is fortunate enough to go into remission needs to check that the GP practice is aware that they will still need retinal screening and need to be coded appropriately to ensure this. Unless PHE are completely mistaken, this is more likely to be a "diabetes in remission" code, with the "diabetes resolved" code more likely for someone who has recovered from steroid-induced diabetes. Obviously, your experience shows that it is not always that simple!

 

[AndBreathe]

Interesting, thank you. It's good that you are still getting your retinal screening despite the "diabetes resolved" code. I wonder if your GP is using different software.

It's a shame that there is still this confusion over terminology when PHE have tried to clear it up. The bottom line is that anybody who is fortunate enough to go into remission needs to check that the GP practice is aware that they will still need retinal screening and need to be coded appropriately to ensure this. Unless PHE are completely mistaken, this is more likely to be a "diabetes in remission" code, with the "diabetes resolved" code more likely for someone who has recovered from steroid-induced diabetes. Obviously, your experience shows that it is not always that simple!

Nothing about diabetes seems to be binary.

 

[Shaydollar811]

Yes claim it in Jesus name u are healed Amen

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[Shaydollar811]

Way to go nocarbs4me blessing I intend to do the same Praise GOD........ FOR HIS MERCY...

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[NoCrbs4Me]

Way to go nocarbs4me blessing I intend to do the same Praise GOD........ FOR HIS MERCY...

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Can you elaborate? FYI am atheist. Or to be more precise, I'm Pastafarian.

 

[4ratbags]

I always use the term 'remission' as it really annoys me when people say I've reversed it and they assume I'm all of a sudden cured, what they don't realise is that there is a lifetime of self control and keeping carbs to a minimum to keep the numbers down. I'm under no illusion that if I stray from my low carb path my numbers will start to rise again.

 

[ickihun]

Diabetes is a disease.
Can diseases be cured?
Can diseases be put in remission?
Can diseases be reversed?

What is a disease?
A pathological condition of a body part, an organ, or a system resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.

Some diseases can be cured. Others, like hepatitis B and diabetes, have no cure. The person will always have the condition, but medical treatments can help to manage the disease. Medical professionals use medication, therapy, surgery, and other treatments to help lessen the symptoms and effects of a disease.

Which includes diet. If your diet is managing the disease, it's not cured.

Remission - to be set back. Reduced even.

Reversed - to it's original state?
Diabetes original state is still diabetes.

Diabetes is not an infectious disease.
All diseases have different characteristics.

So does diabetes!

 

[phil1966]

I couldn't agree more, @ickihun - IMO diabetes can only be described as "cured" if your blood sugar response is normal under all conditions and is the same as someone who doesn't have diabetes.

For example: I can eat a lot of carbs (over 200 a day) and fasting levels are always in the low 4s with post prandial under 7.

That looks pretty "normal", but it is far from that: I carefully control what type of carbs I eat (i.e low GI only) and balance them with fat and protein to "slow" them down.

As an experiment I tried a bacon roll in a soft white bun: my blood sugar shot up and my Libre showed it peaking at 12.5!

It came down within 2 hours but the simple fact that it went that high clearly illustrates my blood sugar response is not normal and I still have diabetes: a non-diabetic would never see blood sugar readings that high, even after far more carbs than the 50 that roll contained!

 

[Oldvatr]

Can you elaborate? FYI am atheist. Or to be more precise, I'm Pastafarian.

Show us your collander. I thought Pastafarianism was a 'get out of jail;' card to get extra priviliges. Wot U in 4? {LOL}

 

[andcol]

I couldn't agree more, @ickihun - IMO diabetes can only be described as "cured" if your blood sugar response is normal under all conditions and is the same as someone who doesn't have diabetes.

For example: I can eat a lot of carbs (over 200 a day) and fasting levels are always in the low 4s with post prandial under 7.

That looks pretty "normal", but it is far from that: I carefully control what type of carbs I eat (i.e low GI only) and balance them with fat and protein to "slow" them down.

As an experiment I tried a bacon roll in a soft white bun: my blood sugar shot up and my Libre showed it peaking at 12.5!

It came down within 2 hours but the simple fact that it went that high clearly illustrates my blood sugar response is not normal and I still have diabetes: a non-diabetic would never see blood sugar readings that high, even after far more carbs than the 50 that roll contained!

Well I eat 1/2 lb of liquorice or a bag of mints and I go to the 8s and no higher. I would say that is normal. Oh and a bacon roll shows the same result. So does a plate of chips! That makes me "normal" and therefore cured in your definition.

So just to make the point it is achievable for some so please do not tell people it isn't as I and a couple of others on this forum are the exceptions that break your proof!

 

[SunnyExpat]

Well I eat 1/2 lb of liquorice or a bag of mints and I go to the 8s and no higher. I would say that is normal. Oh and a bacon roll shows the same result. So does a plate of chips! That makes me "normal" and therefore cured in your definition.

So just to make the point it is achievable for some so please do not tell people it isn't as I and a couple of others on this forum are the exceptions that break your proof!

I can't disagree with you, but there can be some naysayers on here at times, unfortunately.

 

[4ratbags]

We are all different, thats what makes diabetes sooo interesting. I can eat chocolate no problem but not a piece of bread!

 

[ickihun]

Well I eat 1/2 lb of liquorice or a bag of mints and I go to the 8s and no higher. I would say that is normal. Oh and a bacon roll shows the same result. So does a plate of chips! That makes me "normal" and therefore cured in your definition.

So just to make the point it is achievable for some so please do not tell people it isn't as I and a couple of others on this forum are the exceptions that break your proof!

I was quoting from the dictionary so you need to tell them mate!

Edited to say. And Wikipedia.
So understandable when their info wrong. Maybe?

 

[Oldvatr]

I think if this was a cancer forum, then we would be talking remission rather than reversal. I would be happy with remission.