Thread by @omlakhani

1. Any form of weight loss can lead to diabetes remission. (The right word to use here is remission and no reversal.) You DON'T NEED LOW CARB DIET for the same. The same can be achieved with any strategy which produces weight loss

https://twitter.com/serioustaurean/status/1419690292505038849

2. Similar results can also be achieved with a balanced low-calorie diet, meal replacement (as shown in the DIRECT trial), bariatric surgery (as shown in several trials) and SGLT2i/GLP1 receptor agonist (as shown in several trials)

3. While we talk about "low carb" diet or any other fancy diet, how many patients do we know are able to sustain it over a long period of time ? Answer 0. Any form of unnatural diet cannot be sustained by any patient over a long period of time.

Anything sustainable requires a balanced approach.

4. The aim of diabetes management is NOT to correct the HbA1c alone. The aim is to prevent microvascular and macrovascular complications. Several drugs like SGLT2i have proven to reduce cardiovascular risk.

Denying these patients medications proven to reduce CV and microvascular risk over a fad diet is simply unethical. Diet is NOT a substitute for medications and vice versa.

5. The following infographic clarifies the various issues with such diets.

6. These are dietary fads. They come and ago. Low carb diet is basically a reborn version of the Atkins diet. The diet went into disrepute when Dr. Robert Atkins himself died of cardiovascular disease. This new fad is a old wine in new bottle.

7. We have 100s of patients who have achieved diabetes remission with even higher HbA1c using sensible evidence-based diabetes management. They are now off medications and doing very well. They are NOT on any special diet.

Hope this answers the question Kapil

https://twitter.com/KapilDave88/status/1419713653297717278?s=20

PS: A CGM of a recent patient. Came with HbA1c of 11.0 Started timely on Insulin + OAD. Gradually both insulin and OAD were stopped. This is the CGM after 3 months of stopping all medications. He was NOT on a balanced low-calorie diet and did not require any low carb diet