This Time story reports a study about reversing recently diagnosed diabetes via substantial weight loss. One strength of the story is its description of what happens in the body with diabetes and how medications deal with blood sugar, but not the underlying problem. The story competently describes the study methods and findings, but does not address any downsides, namely potential harms or costs, of the strict diet that was used to achieve the weight loss.
New ways to treat type 2 diabetes are always newsworthy because the numbers of people with the condition are so large — about 30 million Americans, or nearly 10% of the population, have the disease. What’s newsworthy here is that a short extreme dietary intervention, followed by a less extreme intervention, was adhered to by nearly 80% of people and led to remission of diabetes in a large percentage of them. It will be important to see how these people do in the long-run–if the remission stands the test of time.
The story makes no mention of costs, although the diet intervention included weeks of a liquid formula diet, along with support services such as nutritional education and cognitive behavioral therapy.
The story quantifies how much weight people lost and how many people went into remission, both in the group on the liquid diet and the control group (in which subject received the usual care for diabetes). That’s good, and worthy of a satisfactory.
However, the story does not explain what remission is or how it was measured. The study used hemoglobin A1c levels, which indicate blood sugar levels over the previous three months, and is often used to diagnose type 2 diabetes. Remission was defined as having a hemoglobin A1c level below the threshold for diagnosis without taking any diabetes medications. (This good outcome might still be characterized as pre-diabetes.)
In addition, readers aren’t told how high blood sugars readings were before the diet, so it’s impossible to tell how big the change was with weight loss.
Harms of the very restricted diet were not mentioned. Were there any problems resulting from months on the liquid diet? Did subjects have trouble adhering to the restrictions?
There were quite a few side effects during treatment. According to the study, during the intervention, most common side effects/complaints were constipation (56%), headache (45%), increased cold sensitivity (44%), dizziness (42%). These tended to dissipate over time.
The story adeptly described the size, randomization of subjects, and control group nature of the study.
The story mentions several difference outcomes in terms of weight loss — “most of the people in the diet group lost about 22 pounds” and “nearly a quarter of the people who managed their weight were able to lose 33 pounds or more.” We found this phrasing vague and a bit confusing and still don’t know what the average weight loss was in the diet group.
No disease-mongering about diabetes here. The story would have been stronger if it had discussed that remission is not the same as a cure–the disease can recur if the behavior change isn’t maintained.
The story quotes a study author but no other sources. We think readers deserve to hear from experts not involved with the study at hand to provide context about the findings.
The story mentions gastric bypass surgery as another method to dramatic weight loss and that has been shown to reverse diabetes. It also mentioned the high cost of and risk of complications from gastric bypass. Unfortunately, readers cannot compare the cost and harms of the managed diet approach, as the story omits their mention.
The story outlines the components of the diet, but not whether an interested could access such care from a physician. Given the extremeness of the diet — the first months are limited to 850 calories a day and education and therapy adjuncts are brought in to help people maintain their progress when switching from the liquid nutrition to real food, not to mention a mountain of evidence on the difficulty of maintaining weight loss — it seems likely that health care providers’ help would be necessary.
The story distinguishes the study’s finding from other diabetes-related evidence. Weight loss has previously been shown to prevent people with prediabetes from progressing to diabetes and to help manage diabetes itself. This study shows that a short, extreme intervention can lead to longer term remission.
The story does not appear to rely on the new release put out by The Lancet, the journal that published the study.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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