# DUK Blog: What is Type 2 Remission?



## Diabetes UK (Aug 30, 2018)

*Douglas Twenefour and Emily Burns explain...*
Type 2 diabetes is serious. If it’s not managed properly, the consequences include a higher risk of amputations, heart disease and sight loss. We also refer to Type 2 diabetes as a lifelong condition. But what if there was another option?

 The world is beginning to talk about remission. And while we still have a lot to learn about the concept, there’s definitely hope. Let’s sum up what we know so far...

https://blogs.diabetes.org.uk/?p=10727


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## Eddy Edson (Aug 30, 2018)

The Newcastle Uni ReTUNE study is interesting - looking into whether the ~50% remission rate for overweight T2D's from the DiRECT study can be extended to normal-weight T2D's.

Looks like they're recruiting for the study: https://www.ncl.ac.uk/magres/research/diabetes/newstudy-retune/


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## Diabetes UK (Aug 30, 2018)

Yes - it seems like a logical next step after the DiRECT,  study which only looked at participants who were overweight.


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## AndBreathe (Aug 30, 2018)

I can totally see why early studies focused on those carrying extra weight, as they tend to be in the majority at diagnosis, and to be honest, I feel that in years gone by, many people diagnosed when slim were immediately categorised as T1, simply because of that - in the same way younger folks tend to be assumed T1, sometimes in the absence of specific testing.

On DCUK, their Low Carb Programm has been returning impressive results for some time now.  There are several presentations, by folks from DCUK to Low Carb Breckonridge, Low Carb Down Under and other highly regarded gatherings, on YouTube, with their data to date.

For me, the tide is turning on how T2 is regarded.  

Like any other condition, not everyone will be able to reverse/send their condition into remission (cure is just too much of an emotive word at present for me), for a plethora of reasons, including the stark rreality that whilst almost anyone not fitting into the T1 category is categorised as T2.  This is usually without regard to why that person's blood sugars are dysregulated or why their metabolic function has gone wrong.

I think there has been fabulous progress in understanding some aspects of T2 in recent years, but really we've just scratched the surface to far.  That said, there has ever been a better time to be diagnosed with diabetes, or whatever sort.  Hopefully my sentiment will be seriously outdated before too long.


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## travellor (Aug 30, 2018)

I think DCUK tends to focus on diet control, true remission is the ability to eat a normal diet, not having to continue a low carb diet to most people.

The often high fasting level seen with low carb (dawn phenomenon), and the various ways needed to manage it, and the high spikes seen after a higher carb meal widely reported on there don't seen to compare to the results from Direct study, where a normal diet has been reintroduced, and real remission has been observed.


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## AndBreathe (Aug 31, 2018)

travellor said:


> I think DCUK tends to focus on diet control, true remission is the ability to eat a normal diet, not having to continue a low carb diet to most people.
> 
> The often high fasting level seen with low carb (dawn phenomenon), and the various ways needed to manage it, and the high spikes seen after a higher carb meal widely reported on there don't seen to compare to the results from Direct study, where a normal diet has been reintroduced, and real remission has been observed.



DCUK, and Diabetes UK, in my view, focus on empowering people to improve their health, by whichever methods they choose.  That DCUK was ahead of the curve in terms of LC eating for T2s is a small part of it all - again, in my view.

In terms of post DiRECT study ways of eating, I haven't seen anything that states what individuals should eat, aside from that there should be less of it.

Personally, I didn't utilise the ND on my journey to a pretty decent A1c and ability to pass an OGTT, but when I corresponded directly with Professor Taylor, in 2014, he stated that post-ND LC seemed a popular way of eating.

Again, personally, to wind up, I couldn't really care what method any given individual uses to improve their health, provided it isn't dangerous along the way or illegal.  I would simply prefer that those diagnosed with a potentially life threatening didn't have to work out quite so much for themselves in a way that seems to be supported less rather than more, more than often.

Anyone who reaches a healthy place deserves credit, after all they are the only ones who will have to live with their longer term outcomes.


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## travellor (Aug 31, 2018)

Well, we all have a view on type 2, but to be fair this thread is about type 2 remission specifically, not how to control it on a daily basis by a restricted diet.
But you are spot on, the DiRECT study doesn't need to specify any restricted diet post remission, because that is exactly the difference between remission, and diet control, as you noted.
And as you say, we'll all find out long  term where our choices ultimately lead.


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## AndBreathe (Aug 31, 2018)

travellor said:


> Well, we all have a view on type 2, but to be fair this thread is about type 2 remission specifically, not how to control it on a daily basis by a restricted diet.
> But you are spot on, the DiRECT study doesn't need to specify any restricted diet post remission, because that is exactly the difference between remission, and diet control, as you noted.
> And as you say, we'll all find out long  term where our choices ultimately lead.



Travellor, I am now eating a diet I enjoy and find I am well and healthy on, and you seem to have your own vision of what that is.  

The post-Direct study advises people restrict their diet, by quantity.  Pedantic I know, but there we go.

There is no silver bullet, Holy Grail, in terms of treatment/management/cure* (*select term of your choosing), or we'd all be doing exactly the same thing and not on here, as "here" wouldn't be required.  

I'm not here to pick spats.


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## SadhbhFiadh (Aug 31, 2018)

I thought it interesting that those who had bariatric surgery had lower bg's immediately post-operative. Prior to any weight loss. I would guess that's down to [imposed] carbohydrates control.


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## travellor (Aug 31, 2018)

SadhbhFiadh said:


> I thought it interesting that those who had bariatric surgery had lower bg's immediately post-operative. Prior to any weight loss. I would guess that's down to [imposed] carbohydrates control.



Low calorie, very little fat, in fact the shakes are mainly carbs, some protein, minimal fat.


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## SadhbhFiadh (Aug 31, 2018)

travellor said:


> Low calorie, very little fat, in fact the shakes are mainly carbs, some protein, minimal fat.



But how many carbs? 
   I count carbs, I hover between 80-90g/day. But calories can be anywhere from 400 to 1800 depending on the day.


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## travellor (Aug 31, 2018)

AndBreathe said:


> Travellor, I am now eating a diet I enjoy and find I am well and healthy on, and you seem to have your own vision of what that is.
> 
> The post-Direct study advises people restrict their diet, by quantity.  Pedantic I know, but there we go.
> 
> ...



I'm glad you have managed to control your diabetes by diet, and enjoy the diet you are on.
That's the good thing about this site, everyone has a method, and they can all be heard equally.

But, it would seem your definition of "remission" includes diet control, which obviously suits you.
I prefer to use my definition, which means I am symptom free, with no drugs, and no diet.
But as you say, little point in arguing over what the word means.

We can all make our own decisions after all, as you rightly say.


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## travellor (Aug 31, 2018)

SadhbhFiadh said:


> But how many carbs?
> I count carbs, I hover between 80-90g/day. But calories can be anywhere from 400 to 1800 depending on the day.



I have no idea, I never counted them to be honest.
Just stuck to low calorie, as you do.


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## AndBreathe (Aug 31, 2018)

travellor said:


> I'm glad you have managed to control your diabetes by diet, and enjoy the diet you are on.
> That's the good thing about this site, everyone has a method, and they can all be heard equally.
> 
> But, it would seem your definition of "remission" includes diet control, which obviously suits you.
> ...



For the avoidance of doubt, this is the definition of remission I tend to go with:  https://www.diabetesremission.org/our-task/


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## travellor (Aug 31, 2018)

AndBreathe said:


> For the avoidance of doubt, this is the definition of remission I tend to go with:  https://www.diabetesremission.org/our-task/
> 
> View attachment 9779




Can't argue with that.
No drugs, no diet control, just back to a completely normal lifestyle, and a full spectrum of food, with no restrictions.
Sometimes we agree with an American definition.
(Not entirely sure why they have three definitions of remission, but hey ho)


No arguments from anyone on here for that as well I would guess.
And very glad we have found an agreement.
As you say, this forum is a friendly, multi solution environment


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## Eddy Edson (Sep 1, 2018)

Hannah DUK said:


> Yes - it seems like a logical next step after the DiRECT,  study which only looked at participants who were overweight.



This 2015 paper seems to set out the hypothesis for ReTUNE:

https://www.ncl.ac.uk/media/wwwncla...cecentre/files/PersonalFatThreshold_Paper.pdf

_Type 2 diabetes (T2DM) is frequently regarded as a disease of obesity and its occurrence in individuals of normal body mass index (BMI) is often regarded as indicating a non-obesity-related subtype. However, the evidence for such a distinct, common subtype is lacking. The United Kingdom Prospective Diabetes Study (UKPDS) cohort of people diagnosed with T2DM in the 1970s and 1980s had a median BMI of only 28 kg/m2. UKPDS data form the basis of current understanding of the condition even though one in three of those studied had a BMI of less than 25 kg/m2. BMI, though, is a population measure and not a rigid personal guide. Weight loss is considered de rigueur for treating obese diabetic individuals, but it is not usually considered for those deemed to have a normal BMI. Given the new evidence that early T2DM can be reversed to normal glucose tolerance by substantial weight loss, it is important to explain why non-overweight people respond to this intervention as well as obese individuals. *We hypothesize that each individual has a personal fat threshold (PFT) which, if exceeded, makes likely the development of T2DM. Subsequent weight loss to take the individual below their level of susceptibility should allow return to normal glucose control. Crucially, the hypothesized PFT is independent of BMI.* It allows both understanding of development of T2DM in the non-obese and remission of diabetes after substantial weight loss in people who remain obese by definition. To illustrate this concept, we present the distribution curve of BMI at diagnosis for the UKPDS cohort, together with a diagram explaining individual behaviour within the population. The concept of PFT is of practical benefit in explaining the onset of diabetes and its logical management to the non-obese majority of people with T2DM._

I have BMI around 25 and the current advice from my diabetes team is "Try not to lose too much weight" (I've lost ~3kg since the DX but given the advice, weight loss hasn't been an explicit goal). The team hasn't heard of the Newcastle stuff & it doesn't seem to have infiltrated much into Oz diabetes-consciousness. Project now is to educate them a bit, starting with Taylor's brief advice to GP's: https://www.ncl.ac.uk/media/wwwncla...centre/files/2017 Information for doctors.pdf


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## travellor (Sep 1, 2018)

Eddy Edson said:


> This 2015 paper seems to set out the hypothesis for ReTUNE:
> 
> https://www.ncl.ac.uk/media/wwwncla...cecentre/files/PersonalFatThreshold_Paper.pdf
> 
> ...



I was diagnosed with an obese BMI.
I lost weight slowly, to a normal BMI, but although I achieved good results, I didn't "reverse" my diabetes.

I then went on the low calorie Newcastle diet, and lost more weight.

This did achieve remission, so I wonder if I either have a very low threshold, or if the speed of loss, or the low calories where the driver.
It certainly was a noticeable step change though.
I have put an amount of weight back on, (as I did look ill), and this doesn't appear to have affected me badly.

His research is something I follow, and it will be interesting to see the results of others who start with a "normal" BMI.


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## Eddy Edson (Sep 1, 2018)

travellor said:


> I was diagnosed with an obese BMI.
> I lost weight slowly, to a normal BMI, but although I achieved good results, I didn't "reverse" my diabetes.
> 
> I then went on the low calorie Newcastle diet, and lost more weight.
> ...



It is interesting. I guess if the PFT concept holds up it might well have a genetic component which could explain some of the family-history risk for T2D.

My father and his father were both non-obese T2's & I seem to have inherited their body shape, FWIW.

Taylor's notes for GP's suggest weight reduction to "low-normal" levels for T2's with BMI's slightly above 25, for the initial phase, which I suppose means a target BMI around 20. But presumably that's just rough guidance, at the moment.


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## travellor (Sep 1, 2018)

Eddy Edson said:


> It is interesting. I guess if the PFT concept holds up it might well have a genetic component which could explain some of the family-history risk for T2D.
> 
> My father and his father were both non-obese T2's & I seem to have inherited their body shape, FWIW.
> 
> Taylor's notes for GP's suggest weight reduction to "low-normal" levels for T2's with BMI's slightly above 25, for the initial phase, which I suppose means a target BMI around 20. But presumably that's just rough guidance, at the moment.



I'm certainly wondering if the type of weight loss plays a part in it.
Certainly, any weight loss is good, if you have weight to lose, so fast or slow has benefits, but his methodology is unique in rapid weight loss over a short period.
Nothing else seems to have achieved similar remission.
And, I've put some weight back on, so there must have been a specific trigger event in my low calorie diet, which hasn't reversed.


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## HOBIE (Sep 1, 2018)

Can you imagine a car engine covered in blankets, its going to get hot ? Same as a human over weight. Not running at best performance ? Blunt but true ?


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## travellor (Sep 3, 2018)

An excellent spot on Radio 2 now. Supporting how the loss of weight (And fat), coupled with exercise is especially good for you.


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