Comments on Type 2 Diabetes: Treating Not Managing
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John Sullivan
June 24th, 2020 at 4:44 pm
Commented on: Type 2 Diabetes: Treating Not Managing
Well at least the Lancet community is looking for a non drug alternative to actually reversing and preventing type 2 diabetes but calorie restriction is almost a sure fire way to fail in the long run. They could have gotten dramatic results by getting people off sugar and carbs in about 30 days. I have to wonder if they even wanted to reverse the illness.. Weight loss is not the driving factor in type 2 diabetes reversal. The elephant in the room that nobody wants to discuss is sugar. You want the truth ?? Follow the money trail. The solution is so simple. Get off the couch and off the carbs NO SUGAR... It's a drug for goodness sake. And although the food manufactures and COKE are partially to blame the ultimate responsibility falls to the individual. It is not the governments job to keep us healthy.
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Tyler Hass
June 24th, 2020 at 6:47 am
Commented on: Type 2 Diabetes: Treating Not Managing
A few quotes from the commentary I found interesting.
“The findings from DiRECT strongly suggest that the key to diabetes remission is weight loss. The investigators tested a rapid weight-loss regimen, aiming to achieve an initial 15 kg weight loss, which they regarded as a threshold at which remission was more likely. However, the trial results suggest a linear relation: the greater the weight loss, the greater the chance of remission, with no apparent threshold.”
I like what was written in the summary, that the weight loss might be a result of better insulin management, not the other way around. JR made a great point that any reduction in calories also implies a reduction in carbohydrates.
“Multiple visits bring substantial additional costs to the health system, patients, and the wider economy (since such appointments will often require time off work). Irrespective of cost- effectiveness, providing this programme at scale would challenge primary care provision worldwide. For example, in the UK, people see a primary care nurse for 1·28 10-min appointments per year on average.12 If 25% of people with type 2 diabetes were to follow the DiRECT programme, this would necessitate a roughly 50% increase in total nurse consultation time and therefore workforce.”
Let me put on my green eyeshade for a moment and play accountant. Yes, there would be an increased cost to offer nutrition counseling to people. Especially at the onset. I suspect this cost would be offset over time by the reduced cost of medications and treatments for diabetes complications. Of course, people might live longer and collect more social security checks...but that's not really a problem for public health.
And how sad is that the average person gets 12 minutes of attention per year from a doctor?
“…about half of the intervention participants resumed their total diet replacement on at least one occasion, but even so, there was a mean of 2·6 kg weight regain between the 12-month and 24-month assessments, so further evidence is needed.”
Pretty typical of most calorie reduction diets. What I would love to see in the future is a head-to-head competition between Virta, DIRECT, Jason Fung's IDM and see whose program wins. It would be nice if the free market could pick the winner, but healthcare is about as far as you can get from a free market.
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Richard Feinman
June 24th, 2020 at 2:22 am
Commented on: Type 2 Diabetes: Treating Not Managing
My library does not get this journal. I would be grateful for a copy. The question I would search is the extent to which the authors compare those results to those of Hallberg, et al. which appear to be better and require a far less demanding intervention.
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jr Wild
June 24th, 2020 at 4:54 am
I did once compare, superficially, Virta vs. DiRECT. There is a draft available for 2 years at https://www.directclinicaltrial.org.uk/Publications.html
Virta had worse patients with longer duration of t2d than Direct. Virta did not exclude insulin injectors, Direct may have done so. Virta had better outcomes in each and every measurement.
Putting these two together, they are successes both. Usual care was useless in both. As usual.
Direct has this obsession into "weight loss" and "balanced" nutrition. They miss the point that 50% of 800kcal is 100g of carbs. Without realising, they apply low carb diet. Below, they acknowledge Virta (30) but negate it the following sentence (31). Not randomised vs meta-(r)ct? The latter I wish not to open, reminds me of Naude &all "fraud/stupidity" in Noakes trial.
"A recent study of people with type 2 diabetes has demonstrated
substantial weight loss, reduced glycaemia and decreased medications with a very low carbohydrate
diet, although this was not randomised .30
However, meta-analyses of the controlled trial evidence
show no important differences between high and low carbohydrate diets for weight control or
Comments on Type 2 Diabetes: Treating Not Managing
4 Comments