a sobering finding is the duration of remission waned over time in Look Ahead:pic.twitter.com/kwJLIMlXZ2
Epidemiologist. Writer (Guardian, Observer etc). "Well known research trouble-maker". PhDing at @UoW Host of @senscipod Email gidmk.healthnerd@gmail.com he/him
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a sobering finding is the duration of remission waned over time in Look Ahead:pic.twitter.com/kwJLIMlXZ2
and that the durability of remission from year one to 4 was poor despite a very intensive model of behavioural change:pic.twitter.com/wmGZB81ZtP
even those w/ a 10% weight loss (many would presumptively have T2D remission) at 1 yr had a 20% RRR in MACE --> a significant value which supports notion that T2D remission would likely lower events (still points toward residual risk) https://doi.org/10.1016/S2213-8587(16)30162-0 …
Then the DiRECT trial came out and at one year with a very low energy diet with initial meal replacement system, they discovered something remarkable -- a 46% remission rate! This was durable at 2 yrs at which time it was 36% (>3 fold more than Look Ahead)!pic.twitter.com/oUFok6Jj89
And meanwhile Virta with a innovative clinical model utilizing remote care, advanced technology, artificial intelligence, and the 'technology' of nutritional ketosis is similarly seeing remarkable results at 2 yrs with 53% partial remission & 17% complete https://www.frontiersin.org/articles/10.3389/fendo.2019.00348/abstract …
Granted I think others such as @GidMK are bringing up useful criticisms of the study design. If Virta's study was carried out within an RCT with proper statistical comparisons, how would it compare to Look Ahead trial which left us feeling a bit disappointed?
TBH my biggest criticism of Virta is that everyone paints it as a "keto" intervention, but it's also a massive lifestyle intervention as well which makes that unhelpful
When I tell colleagues about Virta, they are excited until they hear about the price-tag. No one is surprised when I say that people go into remission quite often when you have to spend $5,000 AUD per year on the program!
What does a year of dialysis cost? I work in tertiary care. The downstream costs related to T2D complications are astronomical. We've just come to accept them.
Oh that's absolutely true. I'm more pointing out that Virta is an intensive, expensive lifestyle intervention that includes but is not limited to a keto diet
I don't think you can say, based on the Virta study, that "keto" is effective for diabetes revision per se. What you can say is that an intensive intervention costing $5,000 a year that includes a keto diet may be effective although this should probably be confirmed in an RCT
An important difference here is also that they participants are paying for the treatment out of their own pocket That of course increases the likelihood of you getting patients with high compliance compared with the dialysis that is payed for by the government in most countries
I'm not sure I follow. The evidence for paid vs non healthcare and compliance is fairly mixed, and Virta is mostly billing insurance companies rather than patients directly from my understanding anyway
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