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Type 2 diabetes: New treatment eliminates insulin for 86% of patients
by amichail
I wouldn't ignore the effect that having surgery and then two weeks of a strictly controlled food intake has. That might account for a large proportion of the success rate. I heard about a study that found that the fasting required for bariatric surgery actually provides a large proportion of the benefit of the procedure.
If you catch type 2 diabetes before it gets so bad that it has killed off the beta cells, then your best treatment is to fast for a while. After a couple of days, you should notice a massive improvement in glucose control. A week of fasting a couple of times a year might be all it takes to give you a complete cure. YMMV, but in my opinion (and that of a whole load of people who know what they're talking about) it's better than filling yourself with drugs.
After the beta cells have been killed off by overwork, yeah, you need insulin. But you can still reduce the amount you need by losing weight.
> A week of fasting a couple of times a year
By “a week of fasting” you mean a week of intermittent fasting or something else? Can you give an example of such a regime (and are there different ways?)?
Don’t have type 2 yet but has family history and it spiked to 6.1 one right after a hospitalisation so I have been spooked since (been 2 years). I get super stressed even at the thought of sugar related tests.
>the fasting required for bariatric surgery actually provides a large proportion of the benefit of the procedure
Can confirm. My wife had surgery ~3 years ago. I supported her by eating the same things she was for prep and throughout the surgery. We lost about the same amount of weight, through ~1600cal a day and exercise. I wanted to get down about 25lbs lower than my lowest during that time. But, a year ago my wife was diagnosed with cancer, and that process totally screwed with our plans, and we both gained weight, her quite a bit less than me.
The last ~6 weeks I've been restricting calories again, and have started the journey back to where I want to be. I will say that the surgery really impacted her hair badly, which she didn't love. Despite taking all the best vitamins, her hair went from thick to somewhat thin.
If you can get rid of the things that trigger you and stick to low calories and exercise, you'll lose weight. The surgery helps, but committing to low calories is going to get the results. And a friend who got bariatric surgery but wasn't committed to lifestyle changes, within a year was back to her original weight.
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For type-2 diabetes, various forms of dietary therapy such as nutritional ketosis have proven extremely effective in reducing or even eliminating many patients' need for exogenous insulin. But we usually refer to that as putting the condition into remission rather than a "cure".
> But we usually refer to that as putting the condition into remission rather than a "cure"
Because that’s accurate. Someone following this treatment plan is still at elevated risk of recurrence. Once you’re cured of the flu, your ex ante chances of catching it again are no higher. (We don’t have a cure for diabetes per se. Insulin controls but doesn’t cure it.)
This.
I was diagnosed with type 2 diabetes about two and a half years ago. After doing some research, I put myself on a strict keto diet. Within about a month, my A1C went from over 13 to hovering around 6 and has stayed there. Never took any diabetes medication.
I do give myself a "vacation" from the diet about once a month, which I usually reserve for a special occasion.
Do you find that this requires an unusual amount of self-control? I have no reason to manage my food intake, but in the limited times where I have I've found it quite difficult
I did keto for almost a year, and it wasn't that bad. My wife lost 50 lbs and I lost 45lbs. 190 > 145 (I had to put on weight afterward). First of all, you can eat things you enjoy, and you don't have to limit your intake. Basically, eat until you're full. When you're fully in ketosis (~2 weeks) you'll naturally not feel hungry. This is what makes keto great because you're never in a situation where you're hungry (at least after a few weeks).
Eating out isn't as bad as you think when in that position. Get a steak with some low-carb vegetables on the side. You can still have blackberries and raspberries and if you really need to "cheat" you can find some deserts that are no carb. Although best to limit those types of sugars. Use an app / website to track carbs for the first few months.
Just remember you're either in ketosis or not. There's no such thing as a "cheat" day on Keto as going over carb amount can kick you out.
Is there a recommended amount (or formula) of carb intake on keto? I use an app called MacroFactor and it suggests up to 45 grams of carbs per day, but I find it too low. I’m somewhat struggling to stay under that limit.
Also the binary nature of either being in ketosis or not is somewhat disappointing. I unfortunately find it impossible to be on a keto diet for long periods of time due to social situations and eating out. Do you have any advice?
45 seems like a lot, honestly. I think we did 20 at first. The ketones blood test kit is a must have. You have to know if you're actually in ketosis. People can do it at different carb amounts.
Societal pressures can be challenging but it's really not that bad. We ate out quite a bit because of birthdays and such. If you're at a nice restaurant, get a steak and a low-carb vegetable. At Ruth's Chris we did Tomahawk steak with mushrooms. Drink club soda with lime or lemon. Chipotle is a good meal. Chicken steak, guac, cheese, salsa (check their site)
Wingstop was also goto for us. They have quite a few sauces that have no carbs. Eating out is planning. Check the menu; if it's not a chain, you might have to call. We did that a few times. Ask if they put sugar in certain things. Burger with bacon and cheese no bun is also an option. You have to be careful with chicken dishes because they might put a sauce on it.
Remember, it's low-carb, not no-carb, so if you accidentally eat a few pieces of bacon with sugar in it, it's not the end of the world. It's probably not going to be enough to kick you out.
Many restaurants don’t have great options though. I find it really easy to do keto when I only eat at home but if I have to travel I fail almost instantly.
I have done over a year of keto on two separate occasions and found it VERY easy to maintain. I contribute this to a high level of satiety while consuming foods high in healthy fats and protein. I rarely had cravings. My go-to fat is coconut oil which I put in my morning coffee and can add to just about any cooking and soups (coming up on soup season so bone broth and coconut oil is my go to). Just about anywhere you go out to eat you can find something that is keto-friendly. Anecdotally, during both of these stints I did not need to take my long term asthma medication and my frequency of use for my emergency inhaler was considerably lower.
I need someone who control his type 2 diabetes with the ornish diet which is fat vegetarian no sugar or simple carbs...
And maybe the secret is the no sugar nor simple carbs
I’m unsurprised that a large component of the treatment is effectively just “lose weight”. For many years I’ve heard accounts of significant weight loss reversing type 2 diabetes.
Even my allergies are tamed when I am at the right weight and physically very and consistently active. (It might just be coincidence though). Cutting off refined/white sugar almost completely has helped a lot I guess (I do have a sweets cheat day every 3-5 months. It’s not planned but somehow this is how it has worked with visits to friends and relatives).
Is type 2 a permanent disease? Or is like when you lifestyle is bad and your sugar remains high/etc you are suffering from type 2 diabetes, but when your lifestyle and weight and great and sugar is well under control you don’t have type 2 diabetes, but if that changes you can get it again? Or it’s like - once “marked with type 2” no matter the sugar marker results you are a type 2 patient forever?
Anecdotally, I've observed with my own body that there is a very direct correlation between weight and all of the health metrics. And it does not take as much weight change as you might think in order to see the metrics move.
Another thing is consumption. All of my metrics start moving immediately in the positive direction when I'm on a calorie restricted diet, even before I start seeing results on the scale.
I could be unique but I doubt it.
The problem, of course, is that just like CICO, observing the relationship between weight and health is educational but useless as a strategy. If it were that easy there would be no overweight people in the world.
Note: This is about diabetes type 2, not type 1. Might be worth to editorialize the heading in this case.
I really wish the two diseases had different names.
Something that works for 95% of people with diabetes then. Fantastic!
They really should be called different names. The diseases are really not all that similar other than (sometimes) the need to take insulin.
Don't only something like 25% of type 2 diabetics take insulin?
Most people with T2D do not take insulin, it's only useful if your body cannot make a sufficient amount. In my case I have no need for it, the cells became resistant to the effects of insulin. 25% is probably a decent estimate.
eh, I had a brief glimmer of hope
As a T1D I empathize so strongly with this comment.
There was a promising example in China where Scientists cured a single woman who had T1D. It's n=1, but the first step to a cure is curing someone :)
There is a study running for this in the UK currently [0], and I expect there are worldwide studies running now. This is the time for those interested and eligible to register. But for the rest of us, the treatment seems to be inevitable now. The question is how long until it's proven safe, the red tape is cut through, and it enters the market. I would speculate, unless something catastrophic happens, it should be available within 10 years.
No doubt, the current T1D market players will have created some legal moat, so it might be best for the patients if these companies are the ones to bring the treatment to the market. But we shall see - the current big pharma in diabetes space is heavily invested in drug production rather than implantation procedures. It is a very different business model requiring very different facilities, management, and technology.
[0] https://www.diabetes.org.uk/our-research/get-involved/take-p...
Immunology & autoimmune attack is still a wild country where discoveries are being made regularly and only a handful of people have even a rough grasp of the terrain.
n=3 but the other two haven’t been monitored for a year yet. Promising.
Paper: https://pubmed.ncbi.nlm.nih.gov/38692517/
> Recellularization via electroporation therapy (ReCET) is a novel endoscopic procedure that uses electroporation to induce cellular apoptosis and subsequent reepithelization.
... plus GLP-1.
GLP-1s baseline eliminate insulin for about ~40% of people. This boosts that number to 86%.
Note that Tirzepatide also reduces the chance of developing type 2 in the first place by 94%, and I suspect that newer generation receptor agonists will see higher insulin discontinuation rates in general.
Very cool stuff all around. Might finally be able to put this whole obesity-and-diabetes thing to bed.
Tirzepatide side effects sound pretty nasty, though less so than dying in a diabetic coma.
The side effects are wildly exaggerated due to the current social media discourse on the subject.
I am in a pretty close knit community of 100s of people on the subject and while the side effects should not be discounted, figuring out ways to properly take the medication more or less eliminates them completely for nearly everyone.
The current dosing and schedules of the drug (and all GLP-1s for that matter) are largely an effect of what was tested during trials and not what will end up being most effective a decade from now. The rest of it is patient compliance and liability from drug manufacturers.
The most obvious two things to point at are that the half life of Tirzepatide is 5 days while the prescriptions are for 7 day intervals for ease of use. The other would be the rather large jumps in dosing (2.5mg per step) available in injector pen forms and prescribed.
Some bleeding edge doctors are willing to take the risk to go outside dosing and schedule guidelines, but not many.
Even then, the side effects seem to be rather minor compared to obesity or T2D and few and are far between.
I also had similarly reactions to the topic before I started to really look into it and dig deeper. I firmly believe these medications will change society at a level only antibiotics have so far.
I worked in pharmaceutical development and absolutely agree on the labeled dosing point. When each arm of your study costs X00 million dollars and Y years, you dont optimize dosing intervals. Moreover, there is no global optimum due to biologic variability in patients. Some patients are flat out non-responders, and some tolerate dosing intervals 10X the average.
That said, there is nothing magic about aligning the half-life and interval. 50% isn't a minimum concentration threshold for efficacy. depending on the product, it can be anything. Sometimes area under the curve is the relevant parameter. Sometimes you want the product to go under a limit before redosing.
The one part I disagree with is about bleeding edge doctors. Maybe it is my field, but I find doctors to be readily willing to completely ignore the labeling. Statutory protections are high for clinicians operating off label. If someone is interested, I suggest they raise it with their doctor. For most medications, the dosing is far from the individual optimum.
You’re 100% right on the doctor. You also never know the why - some will write scripts to address insurance constraints as well.
As the supply shortages are relieved, I think we’ll see a shift towards more pills. It’s poorly absorbed, so the dosage is way higher.
I was on Rybelsus for about a year and a half. It changed my life, and frankly, being able to skip a dose of I wasn’t feeling great eliminated bad belly side effects.
The side effects are usually short lived. I'm on tirzepatide and had some mild digestive issues for the 1st 3 - 4 weeks and haven't had any since then. My side effects when starting metformin were worse.
Directionally each generation of these drugs targets more receptors and has fewer side effects. Tirzepatide is also amazing in that people lost an average of 20.9% of their body weight in studies. [1]
What if I didn't want to lose weight? Would I be a bad candidate?
It doesn’t make you lose weight per se.
It is best described by me turning the volume down on your desire for a dopamine hit. You’ll eat what you need, vs going for the helping of comfort food. Many people see a more active libido, less alcohol desire and other factors.
We’ll see lots of other indications I’m sure. This drug is like the Keytruda of self control.
Tirzepatide does not force you to lose weight, it makes it much easier to stick to your diet. Maybe too easy, since people who are not prepared to manage their diet may find themselves missing meals accidentally (lots of stories of people losing more than 2 pounds a week, which is very satisfying when it happens but not the healthiest way to drop weight).
Make sure you are getting sufficient calories and you won't lose any weight.
The caveat is that it slows digestion down and this effectively reduces your capacity to eat a lot of food. So maintaining a high calorie diet may require some changes to increase the energy density of your food.
> lots of stories of people losing more than 2 pounds a week, which is very satisfying when it happens but not the healthiest way to drop weight
Folks should follow medical advice and do what works for them, but be aware that these guidelines were established prior to the obesity epidemic. I’d be highly surprised if someone weighing 300lbs vs. the same person weighing 190lbs should be losing weight at the same rate per week.
I imagine these will be updated to be body weight (or fat) adjusted as time goes on, like some doctors are already doing.
How long does this cure last until the unhealthy diet & lifestyle that originally caused the insulin resistance bring it back again?
It's frustrating, as Type 2 diabetes is 100% manageable through diet. You don't even have to exercise, just eat healthy. Today, with the use of continuous glucose monitors, you have all the data you need to make informed diet decisions - you know exactly what "eat healthy" means for your body.
Not sarcasm: I'm sure it would be frustrating to see so much scientific and commercial effort going into treating TIID pharmacologically when you believe the solution is trivial. But you could also consider all of these developments as evidence that the prescription of "just eat healthy" isn't broadly useful.
100% agree, it's a modern cultural problem. We look for drug and technology solutions because "doing the right thing" is hard.
When you say "it's a modern cultural problem", do you mean, as most people appear to mean, "This is not a social problem worth solving, these people deserve it for their moral failings, and their death is a useful example for the rest of us"?
Most people don't actually say it out loud, but this is all directly implied by the "personal responsibility" retort that is wildly popular among people who don't actually suffer from a given malady, in response to attempts to address it collectively.
not OP, but I agree it is modern cultural problem and a personal responsibility problem.
However, I dont agree with your supposition following from that.
I think that obesity is a symptom of a cultural problem worth solving, not an individual moral failing, and there are better ways to learn than death.
There are lots of things in our culture that result in physical and mental sickness. It is good to treat the symptoms, but we should also pay attention to the cause.
Culture operates both at the individual and collective level. One can not exist without the other. One can not change without changing the other. Personal beliefs and actions shape collective culture, and culture shapes personal beliefs.
Biologically, obesity could be seen as a win.
It is the natural consequence of the human body's strategy for finding enough sustenance to drive that big brain over an evolutionary timeline that was mostly dominated by scarcity.
We like to call it a disease because we want to live longer. But all of the consequences happen after most humans have procreated, so there is no evolutionary pressure[0] to change it.
[0] Yes, I understand evolution isn't quite that simple
Obesity reduces fertility for both sexes. This is one of the factors behind declining birth rates.
GLP-1 drugs don’t make you burn fat, they make you eat healthy (or healthier, at least). That’s why they’re so amazingly effective and the reason why is even more amazing - they hack your reward subsystem.
GLP-1 drugs seem to increase resting heart rate. I suspect that also increases total daily energy expenditure, although I don't know that we have reliable data on that yet.
That can happen, but is not universal. My resting heart rate has been dropping (probably in lock step with my weight), it has not risen one bit since I started taking tirzepatide. And my heart rate variability has been trending up, not down.
Why do you suspect it changes energy expenditure?
Friendly fwiw: Your parent clearly does not think it is a "modern cultural problem":
> "when _you_ believe the solution is trivial" (emphasis mine)
> "But you could also consider..."
We have government policy that reshaped American agriculture 70 years ago to lower the cost curve for food. That was accomplished by industrialization of food production. That drives Americans to eat the way they do.
Travel to Italy or France and the difference is shocking — both in terms of the look of the people and the quality of the food.
There are also very relevant cultural differences between the French and Americans. It is not just the food on the shelves, or price, but healthy attitudes and behavior around eating and life in general.
The average American is 50% richer than the average French, and have access to everything they need to eat like one if they choose.
In fact, much of the difference is the French choosing not to eat - both in terms of frequency and quantity.
Healthy food attitudes can absolutely be learned and taught. If you see a 200lb 10 year old, the difference between them and their classmates isn't the contents of the supermarket. Its what is going on at home, the actions of their parents, and what they are learning.
I say this not to blame or pass judgement, but to demonstrate that induvial behavior and actions matter.
> But you could also consider all of these developments as evidence that the prescription of "just eat healthy" isn't broadly useful.
As programmers, we usually prefer to remove code to fix a bug than adding patches on top of buggy code. Let's not pretend that the same logic does not apply here.
That's clearly double unhealthy behavior and will bring unintended consequences. Which might be better than the current predicament but still let's not pretend this is not a "monkeypatch".
Considering the article mentions ReCET and semaglutide, presumably most people in the study weren't resuming the unhealthy diet.
Semaglutide is ozempic. By itself it can be enough to help people get their A1C down through healthier diets.
For me to find the study especially interesting, I'd have to see a comparison between ReCET + semaglutide vs just semaglutide. And upon re-reading I see that's their plan.
> “We are currently conducting the EMINENT-2 trial with the same inclusion and exclusion criteria and administration of semaglutide, but with either a sham procedure or ReCET. This study will also include mechanistic assessments to evaluate the underlying mechanism of ReCET.”
s/Broken ankles are 100% manageable by not walking where you could slip and fall. If only today's society made informed decisions about their walking habits, we wouldn't need all these artificial casts and surgeries. How long does a cured ankle last till the lifestyle of walking around breaks it again?/
>How long does this cure last until the unhealthy diet & lifestyle that originally caused the insulin resistance bring it back again?
Not Sarcasm:
1) We simply don't know. Effects seem durable while people take the drug, but we have limited long term data. We dont have large populations that have taken it for 10 or 20 years
2) When people go off GLP-1 drugs, about 50% of them bounce back to their original weight or gain more. about 50% of people hold steady or go on to lose more weight.
This demonstrates that individual behavior and actions play a critical role, even for people who have taken the drug.
Well, shit. I can't believe it never occurred to these obese people to just eat right!
You, sir, are a modern messiah. Well done.
A big part of the problem is that if you go to a doctor with diabetes, 90%+ he will tell you to use insulin. He won't tell you to loose weight and go on keto diet.
Still popular opinion is that eating meat and fat is bad for you (heart attack) but no many understand that eating sugar and carbs is a highway to diabetes).
In fact many people who go on keto and reverse diabetes report that doctors instead of congratulating them and telling other patients to do the same, tell them that keto diet (i.e. eating lots of meat) will give them heart attacks.
Most people don't know how bad sugar and carbs are because no one tells them.
14 participants
I didn’t seem to get this from the article but this this involve taking semaglutide for the rest of your life or the diabetes returns?
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sir this is not reddit
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