T2 remission? What does the team think??

[LittleGreyCat]

https://www.diabetes.org.uk/about_us/news/remission-new-definition?

Apparently the world wide consensus is now that you are in remission if your HbA1c is below 6.5% and you aren't using any glucose lowering medication.

I'm not sure, by the way, if Metformin counts as glucose lowering medication.
Probably does.

Anyway, this appears to be the threshold between pre-diabetic and diabetic.
I don't feel comfortable with this being regarded as in remission because my view is that there is obviously diabetes there even if you are classed as pre-diabetic.

Remission has been debated a lot on this forum, but I don't think anyone has proposed that "less than 6.5% on HbA1c" is a valid criterion.

 

[Pipp]

I would be concerned that the level below 6.5% (48) for just three months would confer remission status. To some people that would be interpreted a being “cured”. When in fact it means that their levels are in pre-diabetes zone. Also, just three months? I would want to see at least a year, with levels less that 6.0% before feeling confident of remission.

 

[zand]

Since 6.5 is in the orange section on the NHS 50 shades of Diabetes chart I would say that's way too high to be classed as remission.

 

[millenium]

That can probably be considered as the upper limit

 

[Member496333]

Well on the spectrum of diabetic pathology. Not normal.

 

[coby]

Since 6.5 is in the orange section on the NHS 50 shades of Diabetes chart I would say that's way too high to be classed as remission.

I agree with you zand, and would class it as 'great control' rather than remission

 

[Mr_Pot]

It is similar to the definition of cancer remission.

A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/remission

 

[Rachox]

Apparently the world wide consensus is now that you are in remission if your HbA1c is below 6.5% and you aren't using any glucose lowering medication.

I'm not sure, by the way, if Metformin counts as glucose lowering medication.
Probably does.

The definition of ‘Remission’ does vary from organisation to organisation. I personally prefer Virtahealth’s definition as I take Metformin!
https://www.virtahealth.com/reversediabetes
I disagree with defining it after only three months of prediabetic levels, way too quick and too high a level in my opinion. The definition of ‘remission’, as stated in my signature, is only temporary. I think the definition in the article quoted by @LittleGreyCat gives patients the excuse to revert to old habits thinking they are ‘cured’, and for them to ‘fall off the radar’ as far as their HCPs and regular check ups are concerned.https://www.virtahealth.com/reversediabetes

 

[lucylocket61]

I suppose it's to get us off their figures and stop our monitoring and health checks.

Yes, I am deeply cynical about this.

 

[BrianTheElder]

https://www.diabetes.org.uk/about_us/news/remission-new-definition?

Apparently the world wide consensus is now that you are in remission if your HbA1c is below 6.5% and you aren't using any glucose lowering medication.

I'm not sure, by the way, if Metformin counts as glucose lowering medication.
Probably does.

Anyway, this appears to be the threshold between pre-diabetic and diabetic.
I don't feel comfortable with this being regarded as in remission because my view is that there is obviously diabetes there even if you are classed as pre-diabetic.

Remission has been debated a lot on this forum, but I don't think anyone has proposed that "less than 6.5% on HbA1c" is a valid criterion.

Hi
I was pretty annoyed last week when I found that my local practice had labelled me as in remission. As far as I'm concerned, I am still T2 and would quickly revert as soon as I stopped my keto diet.
I didn't say anything though as they are not interested. Can't complain because I am still getting free test strips and my eye tests!

 

[Mbaker]

Might as well go back to aiming for an A1c of 7.0 being the objective. They have set the bar low to enable inferior unsustainable methods to tick a box, follow the money in time.

You could hit 6.5% with chronic exercise and or severe caloric restriction , or a combination, aka Biggest Loser. Just look at some ex sports persons.

My view is that 3 months could mean on track to remission at 6.5%, Between 5.7 / 5.9% and 6.5% after a year (3 or 4 A1c tests in a row) should be partial remission or perhaps in remission to be more positive and encouraging, below 5.7% for 5 years could be full remission; all on no drugs, due to not being a natural requirement inthe general population- a cancer person in remission does not continue chemo or similar.

 

[millenium]

Well on the spectrum of diabetic pathology. Not normal.

It is not bad but can be further improved. If the patient become complacent, it will be a disaster in the making.

 

[Bluetit1802]

Isn't 6.5% (48) the criteria set by Professor Taylor for the Newcastle Diet? I seem to recall it was.
It is certainly the criteria set by my GP Practice, but they do have a code for pre-diabetes, which is "non-diabetic hyperglycaemia"

Edited to correct spelling

 

[ianf0ster]

Perhaps we are too knowledgeable (and too cynical) in here.
For most doctors T2 Diabetes is a chronic and progressive disease. So to get back to pre-diabetes is a fantastic result worthy of celebration.

But in here it's @a good start' or 'on the way' or if only just achieved even 'ho hum' - because we :
A). Know how easily the progress can be lost.
B). Know what is actually possible, not just for the odd case, but for a substantial portion of cases.

 

[lucylocket61]

I am now wondering why, if the cut off is 48, my last visit to the DN last year resulted in her telling me my HbA1c was 51 and she cold not, in all conscious, let me leave without me agreeing to go on Gliclazide to reduce my high numbers? I declined and pointed out that I had long covid which was still, at that point, affecting my numbers. She disputed my long covid as i hadnt had a positive test. I pointed out that this was before testing had become available and the NHS wasnt letting people go to hospital (people seem to have forgotten that part of all this) She shrugged.

I havent been back to her since, nor had opportunity for an update.

 

[Ronancastled]

On the upside it offers great hope for those recently diagnosed, it offers hope where previously there was nothing bar progressive chronic to look forward to.
The downside is that the uninitiated consider it a cure & just revert back to the old ways.

The diagnostic low bar is a worry, especially for those who spend along time in the pre-diabetic zone where increased complication risk & further beta cell damage is a worry.

There would be my definitions.
Remission = Off All Meds + FBG < 5.6 + A1c < 5.7%
Reversal = Off All Meds + FBG < 5.6 + A1c < 5.7% + OGTT < 7.8 @ 2 Hours

 

[ianf0ster]

On the upside it offers great hope for those recently diagnosed, it offers hope where previously there was nothing bar progressive chronic to look forward to.
The downside is that the uninitiated consider it a cure & just revert back to the old ways.

The diagnostic low bar is a worry, especially for those who spend along time in the pre-diabetic zone where increased complication risk & further beta cell damage is a worry.

There would be my definitions.
Remission = Off All Meds + FBG < 5.6 + A1c < 5.7%
Reversal = Off All Meds + FBG < 5.6 + A1c < 5.7% + OGTT < 7.8 @ 2 Hours

I feel that your criteria for remission is (perhaps too ) strict.
I say that (and feel that) I'm in emission. 1yr of HbA1C <5.7% on no medication, but my DP still kicks in every morning FBG has never been below 6.9mmol (though it tends to go down rather than up after my first meal of the day (which is sometime my only meal of the day).

 

[lucylocket61]

On the upside it offers great hope for those recently diagnosed, it offers hope where previously there was nothing bar progressive chronic to look forward to.
The downside is that the uninitiated consider it a cure & just revert back to the old ways.

The diagnostic low bar is a worry, especially for those who spend along time in the pre-diabetic zone where increased complication risk & further beta cell damage is a worry.

There would be my definitions.
Remission = Off All Meds + FBG < 5.6 + A1c < 5.7%
Reversal = Off All Meds + FBG < 5.6 + A1c < 5.7% + OGTT < 7.8 @ 2 Hours

After nearly 10 years of type 2 diabetes, and good control, my fbg is always still around 8. It's what my body does. This is not unusual. Fbg isn't a good indication of control.

 

[Resurgam]

I get Hba1c tests once a year so this would not be applicable.

 

[Mbaker]

My scepticism was due in part to the report that many may not be aware of, where at least 2 of those who were responsible for this so called consensus were also on a panel which has far reaching recommendations for many on this forum and wider. What I am referring to is a report that Mr Douglas Twenefour (Deputy Head of Diabetes UK) and Professor Roy Taylor both had their hands in (similar to the remission definition):

Lower carbohydrate diets for adults with type 2 diabetes (publishing.service.gov.uk)
"Lower carbohydrate diets for adults with type 2 diabetes
Scientific Advisory Committee on Nutrition (SACN)"
Published May 2021

The 2 gentlemen could change the course of food and nutrition which could ripple around the world. Here's some of their finding for the efficacy for low carb:

As per usual there were contradictory statements,

So the problem with the recommendations of both the definition of remission and if low carb should be used is that the people who make the decisions have a differing view to start with (low calorie, whole grains, limited saturated fat, compared to the practioners. A bit like asking a Liverpool fan to assess Man United. They say they have gone out to public consultation, but I was not given an opportunity to speak and on the deciding committees I cannot recognise any of the experts (where's David Unwin, Aseem Malhortra, Zoe Harcombe, Malcolm Kendrick, Trudi Deakin - actual low carb experts.

No other dietary pattern has been tested as much as low carb, including the current and other more restrictive.