I
what Virta are doing & their results are in line with other studies.
However, interesting to see intellectual somersaults performed to justify why the Virta COIs are not really COIs.
"Results are still results" (same true of any pharma trial?)https://twitter.com/bigfatsurprise/status/1130491276544151553 …
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Replying to @Dr__Guess
It's also a bit frustrating to see all of the major research flaws in the Virta trial design dismissed as totally fine by people who will pick apart any study that suggests that there is another way than low carb
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Replying to @GidMK @Dr__Guess
I mean, they're getting great results, but those are within-group comparisons of a non-randomized trial. If this was pharma we'd all be rightly skeptical and probably dismiss the results completely
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Replying to @GidMK
disagree! I think any lifestyle intervention which can get 50% of people off insulin (and half units in other 50%) is pretty exciting clinically. I think they've really shown what can be possible for people.
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Replying to @Dr__Guess
But the problem for me is how much of that is the program and how much may have been influenced by the study design. It's very challenging for me to interpret these results because there's no way to tell how much of a role regression to the mean might have played
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Replying to @GidMK
but I cannot think of a scenario in which people with type 2 diabetes of an average of 8 years duration come of their insulin as part of natural variation?
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Replying to @Dr__Guess
One thing suggested by a friend of mine was the use of newer meds (SGLT2, GLP1, DPP4s). There's also decent evidence that simply being enrolled in a study can help with things like weightloss, as well as the underlying statistical variation
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Replying to @GidMK @Dr__Guess
Also worth noting that you can't tell from this abstract who this analysis was done on - it's possible that this is ITT, but given the previous studies I think it's possible that this is "as-treated" which may be inflating the results
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Replying to @GidMK @Dr__Guess
So it looks like they've published a pre-print and the results are interesting. The between-group differences are significant, although some of them do appear to be attenuated (in particular diabetes reversal/remission)https://www.biorxiv.org/content/10.1101/476275v3.full#T6 …
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That being said, I'm super confused why they used the within-group variation in their abstract, many of the between-group values were similar (although slightly lower) and the within-group comparisons are not nearly as valuable
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