Thread by @Dr__Guess

Sad to see the usual angry responses to the announcement that the NHS is rolling out the "DiRECT"-style plan to help people with T2D achieve remission. (1)

To have the NHS get behind a charity-funded research programme which has pretty solid evidence (clinical and physiological) behind it is fantastic. It's a great option in addition to bariatric surgery. The more evidence and options we have, the better. (2)

Would I like to see more dietary options available in a structured way like this? Like low-carb, high-protein, plant-based? For sure, and I hope we see this sooner rather than later (3)
@lowcarbGP 's work
isrctn.com/ISRCTN26058700
clinicaltrials.gov/ct2/show/NCT03…

And by the way @DiabetesUK are actively looking for ways to help optimise remission for as many people as possible. Many of us attended a roundtable meeting last year and all views were heard and taken on board (including low carb) (4)

The absolutely best evidence we have is that weight loss (however a person can achieve it) has the strongest association with T2D remission, and it's quite correct that this is the principle aim of the new programme (5)

Everyone sensible recognises maintenance of weight loss is crucial - and there is enormous interest in how low-carb or other food-based approaches can help here (and medical and behavioural etc etc). (6)

And thanks to the absolutely brilliant team behind DiRECT, we now have valuable insight into the pathophysiology of "relapse" - it looks like fat redeposition in the liver might play a key role. So we can look at ways of reducing that if/when some weight regain occurs (7)

The point is all of this is positive and great for people living with T2D. It doesn't negate the need (and enormous will) to search for and research other ways of help people with T2D. (8)

Just because you don't want to drink a milkshake and would prefer a food-based approach, so what? Other people might choose a medication which works for them, or they might decide a bypass is the right route for them. It doesn't stop you from choosing the method right for you.(9)

The UK has a fantastic diabetes community: from leadership to research to clinical. There are also fantastic people in primary care bringing other options like low-carb to the table & they generally get heard when they 1) have data & 2) don't slam anyone who isn't low carb too.

Please stop putting people down just because they don't want to eat like you, and let's celebrate all the options we now have to help people living with T2D improve their health in a way they choose to. (11)
THE END.