What a new diabetes remission definition means for you

A new consensus report defines what "diabetes remission" means. While that may be important for clinical trials or medical coding, is it important for you? Here's why I think they missed the mark when it comes to creating a definition helpful for individuals with type 2 diabetes.

DD guides mentioned in this video:

About the study in this video

Table of content
0:00 Introduction
0:55 The consensus definition of remission
3:17 The main weaknesses of this definition
5:19 CGM as a new tool to measure blood sugar
6:26 The concern with diabetic retinopathy
7:21 Dr. Bret's insights about the new consensus
8:12 About Diet Doctor Pro

About us:

[MsTony]

I’ve been in reversal for two years now with an a1c of 5.2 without meds. I’d be interested in more videos about the best diet for long term maintenance of this reversal incl thoughts on whether beta cells can really ever fully recover.

[stephencullum]

My primary care doctor just moved me and the wife into the diabetes remission category. Our A1C has been in the normal range for over two years with no diabetic meds. But I agree if I went back to the SAD it would likely come back.

[areksoo]

These videos are constantly so relevant to my life. I'm right in the category of remission. I went 9 months straight with A1C at 5.0 with medication and then after 3 months off, it went up to 5.3. That was about a month ago. For sure, just because I'm out of the danger zone, it doesn't mean I can eat whatever I want. I'm still on my diet and even stepping up my workouts from running to strength training.

[dtreese]

I talk about reversal when I have someone who has normal glucose and A1c off meds. If A1c is still in the 5.7-6.4 range, I use the remission diagnosis.
Before focusing on dietary change as my primary treatment, I had never done either for a patient. Now, I remove diabetes and prediabetes from problem lists several times a year, and I practice in the obesity belt.

[markiangooley]

A1C of 6.5% was usual for me on a low carbohydrate diet. Of course I still needed insulin, being a type 1 diabetic. Last few tests have been 4.9 with a nearly carnivore diet and aggressive use of insulin.

[janeknight]

Sorry Brett I would go for 6.0 without metformin - but I understand where you are coming from. I would have to constantly monitor to keep the a1c at that level. You are so right about cgm.

[candacev]

I still think reversal is a valid term to use. We don't say that weight loss is in remission even though we know that the weight will come back on if one goes back to old eating habits.

[Cello-Pam]

I'm glad he said the Diet Doctor uses 'reversal' and 'remission' interchangeably. It has been confusing. The two words certainly mean different things to me.

[seanveach]

I am 6.0 without meds, and even though I want lower, would take this over lower with Metformin any day. Metformin seemed to cause cramps and stiffness a lot in me.

[peacenow]

Thank you so much for this video. It was very beneficial. Keep up the Great Work! Much appreciated!

[CarbageMan]

Hey, it's a big deal if it affects insurance coding, etc. I went around and around with the life insurance people over my "history of diabetes" after having been diagnosed in March 2018 and bringing my A1c down to 4.9 before the end of the year, then keeping it under 5.3 every single reading since. I had no "history of diabetes." I had a blood sugar problem, and I _fixed_ it. It needs to be recognized that you can fix it, and keep it fixed.

Let's get beyond this "coming back" idea. Anybody who eats junk is going to end up there, and anybody who eats healthy is not going to be there. They should spend their time worrying about things like CAC scans and carotid scans, etc.

PS: I met the definition of remission before the end of the year, as I brought it down under 6.5 in under six months.

[CarbageMan]

(Not) Funny thing about retinopathy. I had a "hypertensive crisis" and was sent to various specialists, including an ophthalmologist, and I was diagnosed with retinopathy. Diabetes (or pre-diabetes) was never discussed. Three years later, I was diagnosed with diabetes. I went back and checked my labs, and I was almost certainly pre-diabetic at the time.

[my-yt-inputs]

My initial thought is we need to quit using the symptom Type 2 Diabetes and start treating the cause. Insulin Resistance. At least in most cases. You can't reverse or put in remission T2D unless you control the root cause. So in essence what we're really looking for is reversing IR which in turn will get rid of the symptom, T2D. You did touch on this but only slightly. Seems to me using the 6.5 number is too high.
I used a CGM for a year(self pay) to get a better idea of how I am dealing with my IR/T2D. Libre 14 day. I was expecting a pretty low A1C based on Avg glucose readings but ended up with the same 5.8 I had the year before. And this was going full Carnivore after being Keto for the year prior. Yeah the Libre is not to be trusted....at least in my case. Obviously measurements were off by a mile.

[Matticus]

Whats the relationship of Metformin in Insulin Resistance, "craming" sugar in the cells seems to me not a "Remissional" method

[sunkthebirdie]

Metformin with an e seems elegant 😆

Dietdoctor Pro ? Sounds cool 😎

[cassieoz]

It's a massive shift when you consider they used to say remission wasn't possible. Don't forget that several of the consensus parties are not American so the issues of coding and funding are not relevant. Not everything should be interpreted through the 'spectacles' of the dysfunctional American insurance system

[amyc]

Thank you for this wonderful helpful motivational information

[rodee]

I've recently been bottoming out in my sugars no matter what I eat ir how much. Is my insulin spiking? Or am I just less resistant?

[janplesse]

Thanks for your great content. I would be interested to get your take on the new study by Mr Hall „Effects of Low Fat Versus Low Carbohydrate Diets on Energy Metabolism“ published in Nature.

[alsjogren]

Fasting Insulin? If I bring my pre-diabetes A1C into the normal range, what Fasting Insulin numbers would indicate a normal Insulin Sensitivity? My Fasting Glucose is already in the normal range.