Abbott / Apple Librelink SNAFU

 Abbott have updated their Librelink software for the Libre 2 sensor in the UK and the new version 2.10.x has the advantage of streaming glucose values every 60s to the app screen. It works well on Android. https://www.freestyle.abbott/uk-en/home.html

Not much else changed, there's no watch integration or lock screen / notification area display of blood glucose data. But it does work quite well, and the values are pushed through to the Libreview.com cloud and hence on to LibreLinkUp followers continuously.

Unfortunately there were many problems with iPhone / iOS users experiencing white screens when the app updated. This was solvable by deleting the app (and losing up to 90 days data off the phone) and reinstalling. The data is still held at Libreview.com. This problem led Abbott to pull the 2.10.x update from the app store, but not replace it with the old one, leaving no Librelink-GB app on the App Store.

For some reason the Ireland app store still carries their updated version, perhaps the white screen problem didn't arise. https://apps.apple.com/ie/app/freestyle-librelink-ie/id1307010255

So many iPhone Libre users were suddenly left in the lurch with no working app, and no app in the App Store to download.

Abbott released a video https://www.youtube.com/watch?v=LfIbDA8ciSg explaining how to delete the app and then recover it from "Purchased apps" in the user's App Store profile. This seemed to work for the majority, the loss of recent history on the phone was collateral damage. There is now a web page too https://www.freestyle.abbott/uk-en/iphone.html

It seems strange that Abbott did not rewind the update process and just put v2.8.x back on the app store. This would have restored the status quo and given them time to resolve the issue. There are some questions to be answered about the testing regime as after all there's a very limited set of hardware using iOS and an even more limited OS/user interface - surely a beta test by 50 end users would have revealed this problem in advance of messing up thousands of users.

The iOS version 2.10.x does work once installed, although some users were struggling to adapt to the movement of the "Scan" button to a more subtle RFID icon top right as shown below. With the new streaming data feature you only really need to scan to start the sensor and if it won't reconnect.

Type 2 Diabetes Remission - UK Direct Trial update.

Diabetes UK have been publicising unpublished results from a 5 year follow-up of the DiRECT trial where a harsh calorie restriction diet ((825–853 kcal/day formula diet for 3–5 months)) was used to attempt remission of Type 2 diabetes in obese and overweight adults. 85 subjects from the initial intervention group of 149 were included in the follow-up.

After 5 years, 11 people were still in remission with a mean weight loss of 6.1 kg. This compares to an average 5-year weight loss of 4.6kg, with 3.4% in remission, for those in the control group.

At the 3 year point 48 of the 85 had been in remission, so only 23% had sustained remission from years 2-5. The percentage in remission in this group fell from 56.5% to 13%.

After the first year of DiRECT, remission was seen in 68 out of 149 subjects, or 46%. Follow up after the second year reported that 53 of the original 149 were still in remission, or 36%.

This suggests that the 85 people in the extension study had a higher success rate at the outset than the whole intervention group. Even if we scale up the 13% in remission at year 5 from 85 to the original 149 it would suggest 19 long term successes in total.

The other primary goal of DiRECT was to achieve a 15 kg weight loss, not least because remission is much higher if this level of loss is achieved. Despite the severity of the calorie restriction and the amount of support provided only 36 (24%) of original participants achieved this at one year, falling to 17 (11%) after 2 years. The Diabetes UK press release does not appear to clarify how many of the 85 had sustained a 15 kg weight loss at year 5, but reports a mean weight loss in the group of 6.1 kg at year 5 compared to 10 kg in the whole intervention group at the end of the first year.

Dr Nicola Guess has written an article suggesting that there is merit in looking at the macronutrient content of the diet beyond the energy balance, as studies show that liver and pancreas fat can be reduced by carbohydrate reduction without weight loss due to the change in fat use for energy and reducing denovo lipogenesis from high carbohydrate intake. This could improve the success rate and reduce the regression seen in DiRECT where weight loss proves hard to achieve and harder to sustain.