“Lifestyle Programs 'Could Prevent Diabetes, ” Medscape
Medical News declared. My heart skipped a beat. 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,
hypertension and related metabolic 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 to be 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 U.S.’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
all are Pre-diabetic with a “progressive” condition!
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,” only first classified in 2002. (In Europe
6.1—6.9mmol/L or 110mg/dl—125mg/dl; in the U.S.: 100mg/dl—125mg/dl.
The Medscape “good news” spin in the header was inaccurate.
It was not the 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 Off Topic to the NHS rollout, the director doesn’t explain
exactly what those “simple
changes” would be.
The story also points out that “while Type 1 diabetes cannot
be prevented and is not linked to lifestyle, Type 2 diabetes is largely preventable through lifestyle changes.”
Okay, HE KNOWS! T2DM is largely preventable – and 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 [dietary changes, ‘ya think?] 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 just too hot a potato. Or maybe, to be more
cynical, they don’t want a “cure.”
Maybe they just want a
“treatable” condition… to keep their government jobs and the NHS in business.
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