Great thread by @Dr__Guess. To me VLCD are like any other dietary intervention, all are v important part of #obesity treatment. But we need to avoid extreme loving or hating, we just need to see things as they are. DiRECT is a great study, but it is not without sig limitations
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DiRECT showed that VLCD compared to "routine care" was effective in achieving T2 #diabetes remission. This is great, but we need to acknowledge that the 2/3 who did not achieve remission still need to have other treatment options
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I also like @TaraKellyRD comment about the prejudice against VLCD. I agree, this exist and should not be the case. But there is prejudice against everything not VLCD, that should be avoided too. As for adherence, lets see the approx data
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1000 pt contacted, 400 agreed, 150 received VLCD. Out of those 21% did not engage or withdrew from VLCD. So despite multiple layers of selection still a lot did get on well with VLCD. This is neither small nor negligible amount
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When we talk about T2 #diabetes remission with DiRECT, we need to be v clear that the inclusion criteria were very tight, we cannot generalise and the support to pts was great. Ignoring the support and the selection criteria is not wise
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I would like to add here that I often use VLCD in the opposite type of pts to that included in DiRECT, and I had great pts success stories .... but I deliver it with plenty of support from DSNs, dietitians and psychology ) and plenty of me too
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Also we can debate forever whether pre DM is a remission considering the high CVD risk in pre DM, and argue about the lack of data on vascular complications in VLCD and whether VLCD is better than any other diet.
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However, what& #39;s important to me is that NHS England plan puts #obesity managent in the heart of T2 #diabetes and for that I congratulate them. Also v imp to me is to have multiple treatments options and for pts who respond to VLCD then VLCD should be what they get
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