My heart skipped a beat when I saw, in Medscape Medical News, the header, “Lifestyle Programs 'Could Prevent Diabetes.” Had the medical establishment finally come to accept type 2 diabetes as a dietary disease? Had they decided to repudiate the awful advice they’ve been dishing out for half a century and finally effectively address the raging epidemic of obesity, type 2 diabetes and related diseases increasingly plaguing our world?
Or, at the very least, had they perhaps figured out a way to finesse the bad advice for treating these diseases by advocating an intervention before the diseases were firmly established. That would be a brilliant strategy that would in effect, to use an American football metaphor, be an “end run” to evade the usual “middle-of-the-line” defenses. While hope springs eternal, my hopes were soon dashed. It was neither of the above.
The story was just about “updated guidance [that] will give clinicians the confidence to make prevention their priority, indentify those at high risk, and refer them to the UK’s Diabetes Prevention Program.” It was a press release. It did, however, shed some interesting information on what the NHS considers “those at high risk.”
The NHS (National Health Service) is the British equivalent of US’s HHS. The Diabetes Prevention Program was started in 2016. Its crown jewel is the National Institute for Health and Care Excellence (NICE) pilot initiative to offer a place on “an intensive lifestyle change program” to “people who could benefit from advice on their diet and physical activity levels.” The program is currently scheduled to roll out across all of England by 2020.
“Nice says it is currently cost-effective to target people with a fasting glucose between 5.5—6.9 mmol/l [99—124mg/dl]. However, it says those with a higher reading (6.5—6.9mmol/l)[equivalent to 118—124mg/dl] should be prioritized for inclusion because of their increased risk of developing type 2 diabetes.” Geez! All of these people are at “high-risk”for type 2 diabetes. They all have Insulin Resistance and thus incipient T2DM!
Many clinicians and researchers concur with this “extreme” prognostication. Consider that in 1997 the ADA Standard for a medical diagnosis of type 2 diabetes changed from 140mg/dl (7.8 mmol/l) to 126mg/dl (7.0 mmol/l). Yet another change is long overdue. There is already a hue and cry to change the definition of “pre-diabetes,” first classified in 2002. (In Europe 6.1—6.9mmol/L or 110—125mg/dl; in the U.S.: 100—125mg/dl.
The Medscape “good news” spin in the header was inaccurate. It was notthe purpose of the NHS press release.” The NICE center’s director was more on point: “We know that helping someone to make simple changes to their diet and exercise levels can significantly reduce their risk of developing type 2 diabetes.” But perhaps because it is OT to the rollout, he doesn’t explain exactly what those “simple changes” would be.
The story also points out that “(w)hile type 1 diabetes cannot be prevented and is not linked to lifestyle, type 2 diabetes is largely preventable through lifestyle changes.” Indeed! Largely preventable – even reversible – at least in the sense that if you adhere strictly to specific diet changes, type 2 diabetes can be put into complete remission, that is, completely undetectable by a simple laboratory test such as a fasting glucose or an HbA1c.
To your doctor, that’s a cure! And when this disease is in remission, your risk of kidney failure, preventable sight loss, and amputation is de minimis. And your risk of heart attack and stroke reduced by 50% or more!
Diabetes UK’s head-of-care said, “We know that globally, diabetes prevention programs do work, and we know that with the right advice and support, people with increased risk of developing type 2 diabetes can take simple but significant steps to prevent the condition from developing.” The “right advice,” unfortunately was nowhere to be found in this document or in my search of the NICE site. Methinks perhaps it’s too hot a potato. Maybe they don’t want a “cure.” Maybe they just want a “treatable” condition… to keep the NHS in business.