Nezam El-Tayebat 事实核查对“نظام الطيبات”饮食体系的科学评估
选择国家
选择语言: 简体中文

错误 已被科学证据否定 证据确定性: 高 初步 C-INS-10

糖尿病患者遵循 Tayebat 体系（“零药物”）就可以停用胰岛素和糖尿病药物，那些停用胰岛素后“完全没事”的追随者就是证明。

安全提示: 请不要因为这一说法而停用或减少胰岛素。在1型糖尿病和其他胰岛素缺乏的情况下，停用胰岛素会在数小时至数天内导致糖尿病酮症酸中毒，这会危及生命。医学界公认的立场（ADA Standards of Care 2026）：胰岛素治疗对1型糖尿病患者是必不可少的；接受强化胰岛素治疗的人即使不进食，也不应停用基础胰岛素。糖尿病药物的任何调整都应与主治医生共同进行。
简而言之: 该说法错误。停用胰岛素是诱发糖尿病酮症酸中毒的主要原因，在1型糖尿病中是致命的；一些2型糖尿病或酮症倾向糖尿病患者可以减少或停用药物，但只能在医疗监督下、在监测血糖和酮体的情况下逐步进行。
结论: 自行停用胰岛素是危险的；任何减量都应在医疗监督下进行。
  1. 原始表述
  2. 科学评估
  3. 科学证据详解
  4. 通俗解释
  5. 与该说法相关的研究
  6. 地区背景
  7. 在我的国家适用什么？
  8. 参考文献

原始表述

ساره السيد بيقوللك بطل الانسولين الحمد لله زي الفل

按来源为原话. 译文由本项目提供；以阿拉伯语原文为准。

译文

糖尿病患者遵循 Tayebat 体系（“零药物”）就可以停用胰岛素和糖尿病药物，那些停用胰岛素后“完全没事”的追随者就是证明。

出处

来源状态
视频转录文本（本人原话）
归属
Elawady (machine transcript)
视频
Dr Diaa Al Awady د ضياء العوضي is live! الكورتيزون حياتك (打开来源)
发布日期
2025年10月17日
时间戳
1:58:13 (在原视频 YouTube 自动字幕轨中的位置；可确认该内容出现的位置，但不能确认说话人是谁)
归属的不确定性
Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. The primary quote is a viewer's message ('Sarah El-Sayed tells you ...') that Elawady reads aloud and comments on approvingly during a live stream; it is not his own statement. His own statements are in the alternative sources, e.g. PBygUgVhUM8 ('I am the one who stopped it for him') and aEbRfVSJIOw ('zero medicine').
所声称的机制

Removing harmful food inputs restores the body, making insulin unnecessary.

所声称的健康影响

Stopping insulin is safe/curative

涉及人群

People with type 1 and type 2 diabetes

Elawady 设定的地域限制

none found

来源版本存在差异

来源状态
视频转录文本（本人原话）
归属
Elawady (machine transcript)
视频
Dr Diaa Al Awady د ضياء العوضي is live! ٢ (打开来源)
发布日期
2025年8月20日
时间戳
无（转录文本不含时间信息）
归属的不确定性
Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.
来源状态
视频转录文本（本人原话）
归属
Elawady (machine transcript)
视频
Dr Diaa Al Awady د ضياء العوضي is live! مفيش حاجه سعرات مفيش حاجه اسمها نشويات (打开来源)
发布日期
2025年8月7日
时间戳
无（转录文本不含时间信息）
归属的不确定性
Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.
来源状态
视频转录文本（本人原话）
归属
Elawady (machine transcript)
视频
Dr Diaa Al Awady د ضياء العوضي is live! السيليوليت (打开来源)
发布日期
2025年10月11日
时间戳
无（转录文本不含时间信息）
归属的不确定性
Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.
来源状态
视频转录文本（本人原话）
归属
Elawady (machine transcript)
视频
بيان فلسفه النظريه (打开来源)
发布日期
2026年2月14日
时间戳
无（转录文本不含时间信息）
归属的不确定性
Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.
来源状态
视频转录文本（本人原话）
归属
Elawady (machine transcript)
视频
ارتفاع السكر والأسيتون ؟خطر والا ده الطبيعي ؟#ضياء_العوضي (打开来源)
发布日期
2025年12月23日
时间戳
无（转录文本不含时间信息）
归属的不确定性
Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.

科学评估

错误 – 该说法与可靠证据相矛盾。

证据确定性: 高 – 进一步研究极不可能改变该评估。

1. 说法是什么？

Following the system allows people to stop insulin; testimonies show success; the method is 'zero medicine'.

2. 哪些内容可证实是正确的？

In type 2 diabetes of short duration, intensive weight loss can lead to remission off all glucose-lowering drugs in a substantial minority (46% at 1 year in DiRECT; participants on insulin were excluded) (I-FAST-12). Insulin doses in type 2 diabetes can often be reduced when weight falls or when metformin is added (A-INS-19); in a supervised ketogenic-diet programme insulin use fell by 62% (non-randomised, I-DIAB-105). Some adults who first present with ketoacidosis have ketosis-prone type 2 diabetes and could be weaned off insulin under medical supervision (26% at 5 years), whereas antibody-positive (type 1) patients rarely could (I-INS-128). Elawady also says that people who stop insulin are responsible for themselves, which is a disclaimer, not a safety instruction.

3. 哪些内容是错误或夸大的？

Individual success stories told during live streams cannot show safety or efficacy; people who were harmed are not presented. People with type 1 diabetes or advanced insulin-deficient type 2 diabetes cannot stop insulin (I-ODD-16, I-INS-07). A 'zero medicine' rule contradicts the evidence that metformin, SGLT2 inhibitors and GLP-1 receptor agonists reduce death and organ damage in defined groups (I-ODD-01 to I-ODD-07).

4. 哪些内容仍不明确？

How many followers stopped insulin and what happened to them is unknown; no registry or study exists.

5. 哪些研究支持该说法？

I-FAST-12 (diet-induced remission in early, non-insulin type 2 diabetes; limited relevance).

6. 哪些研究与该说法相矛盾？

I-INS-07, I-INS-08, I-ODD-16, I-INS-03, I-INS-108 and I-INS-109 (stopping insulin causes about two-thirds of DKA episodes), I-INS-101, I-INS-102.

7. 对德国和欧洲而言情况如何？

European (EASD) and German (DDG) guidance follow the same evidence base as the ADA/EASD consensus: individualised HbA1c targets, insulin as mandatory therapy in type 1 diabetes, and SGLT2 inhibitors/GLP-1 receptor agonists for people with cardiovascular or kidney disease. No country-specific difference changes the assessment.

8. 关于埃及的已知情况是什么？

Egypt has one of the highest diabetes prevalences in the region; the same drug classes and insulins are used. Access barriers and cost may make advice to stop medication attractive, which increases the practical risk of this claim. No Egypt-specific evidence changes the assessment.

9. 合理的实际结论是什么？

部分2型糖尿病患者有可能减少糖尿病药物，但只能在血糖监测和医疗监督下逐步进行。1型糖尿病患者绝不能停用胰岛素。

评估详情

证据确定性的依据

Anecdotes read out in live streams are not evidence; no outcome data on the system exist. In type 1 diabetes stopping insulin is reliably fatal without treatment. In type 2 diabetes, some people can reduce or stop medication after substantial weight loss under supervision (DiRECT, which excluded insulin users), so the claim is false as a general statement and dangerous for insulin-deficient people.

来源质量

Own words; testimonies are second-hand and unverifiable. Elawady also states that whoever stops insulin is responsible for himself.

地区可推广性

Universal.

个体例外情况

Some people with early type 2 diabetes and weight loss can come off medication under medical supervision (see C-DIAB-03).

说法的地域范围
普遍性（生物学/医学）
最近审核
2026年10月26日 初步

科学证据详解

已被科学证据否定 – 高质量证据显示情况恰恰相反，或该说法与已确立的生理学知识相矛盾。

研究问题: Can people with diabetes safely stop insulin and diabetes medication by following a diet ('zero medicine')?

研究问题详解 (PICO)
人群
People with type 1 and type 2 diabetes on insulin/medication
干预或暴露
Stopping insulin/medication while following a diet
对照
Continuing medication with supervised adjustment
地域范围
universal biology
结局指标
  • DKA
  • Mortality
  • Glycaemic control
  • Successful supervised deprescribing

研究结果按作者报告呈现。我们的评估见下文。

哪些证据支持该说法？

哪些证据不支持该说法？

总体证据说明了什么？

基于上述研究的编辑评估——其本身并非研究结果。

哪种观点有更好的证据支持？

Stopping insulin causes DKA in insulin-deficient people; in selected type 2 or ketosis-prone diabetes, medication can be reduced or stopped only step by step under medical supervision with monitoring.

为什么有些研究权重更大

Direct evidence of harm from insulin cessation and natural-history data outweigh anecdotes; supervised deprescribing evidence is limited to specific T2D phenotypes.

因果关系是否已确立？ 是，已确立 Insulin omission causes DKA.

仍存在的不确定性

Outcomes among followers are unknown.

合理的结论

False as a general statement.

为什么研究结果看起来互相矛盾？

Supervised T2D deprescribing (I-DIAB-105, I-INS-128) and remission trials concern selected people with preserved insulin secretion under medical monitoring; they do not support unsupervised stopping or stopping in T1D.

这是否取决于国家？
一般生物学效应
Insulin physiology, autoimmune type 1 diabetes and ketoacidosis are universal human biology.
饮食习惯
Egyptian and European diets differ, but no dietary pattern replaces insulin in insulin-deficient diabetes.
食品原产地
Not relevant.
污染物
Not relevant.
本国生产条件
Not relevant.
法律规则
Insulin is an essential medicine (WHO list) in Egypt and the EU; prescription rules not relevant to the scientific question.
实际监测数据
No registry of Tayebat followers who stopped insulin exists; harms would not appear in the testimonials presented.

足以改变结论的地区差异没有可靠数据支持。

统计复核
  • Wilson CI for insulin-cessation share – 66.7% (51.6-79.0%) 已重新计算
总体证据的确定性（GRADE，简化版）
主要结局
DKA and death after stopping insulin in insulin-deficient diabetes
起始等级
低（观察性研究）
升级理由
  • very large effect (natural history)
  • consistent mechanism
结果
高

由单名审查者参照 GRADE 方法进行的简化评估；并非正式的 GRADE 专家组评估。GRADE 评价的是针对某一结局的整体证据，而非单项研究。

已核查的临床指南和官方声明
  • ADA: 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026 (2026) · 原始文献
    People at risk for DKA should have ketone testing tools and sick-day advice; people on intensive insulin therapy should not stop or hold basal insulin even if not eating; caution with near-normal A1C goals in long-standing T2D using hypoglycaemia-prone drugs (ACCORD).
  • ADA: 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2026 (I-ODD-16) (2026) · 原始文献
    'Insulin treatment is essential for individuals with type 1 diabetes'; insulin to be considered in T2D when A1C >10%, glucose >=300 mg/dL or catabolic features (as recorded for I-ODD-16).
  • ADA: 14. Children and Adolescents: Standards of Care in Diabetes-2026 (2026) · 原始文献
    For type 1 diabetes 'insulin therapy is paramount'; rec 14.36: start insulin in ketoacidosis; thyroid screening because of autoimmune clustering; in youth T2D maximise non-insulin therapy and consider reducing insulin when goals are met (14.39-14.40).
  • ADA/EASD: The management of type 1 diabetes in adults: updated 2026 consensus report (2026) · 原始文献
    'Lifelong insulin therapy is essential in type 1 diabetes'; all individuals need glucose and ketone testing supplies; insulin omission or under-dosing is a DKA precipitant.
  • NICE: NG28 Type 2 diabetes in adults: management (last updated 18 February 2026) (2026) · 原始文献
    Low-energy and very-low-energy diets via the NHS Type 2 Diabetes Path to Remission Programme (1.3.4); evidence on stopping/switching medicines is limited (research recommendation).
检索策略

本次审查的文献检索记录（检索式采用原数据库语法）。

数据库日期检索式检索目标命中数纳入数
PubMed2026年10月26日"type 2 diabetes" AND ("insulin withdrawal" OR "insulin discontinuation" OR "deprescribing insulin") AND (diet OR lifestyle OR "weight loss")支持性证据20
PubMed2026年10月26日Athinarayanan SJ[au] AND "type 2 diabetes" AND 2 years支持性证据18
PubMed2026年10月26日"ketosis-prone" AND (insulin discontinuation OR "insulin independence" OR remission)双向56
Europe PMC2026年10月26日(TITLE:"stopping insulin" OR TITLE:"insulin omission" OR TITLE:"discontinuation of insulin") AND (outcome OR mortality OR ketoacidosis)反对性证据15
PubMed2026年10月26日("insulin omission" OR "cessation of insulin" OR "discontinuation of insulin") AND "diabetic ketoacidosis" AND (precipitat* OR cause)反对性证据72
PubMed2026年10月26日Musey VC[au] AND ketoacidosis反对性证据1
PubMed2026年10月26日Randall L[au] AND recurrent diabetic ketoacidosis反对性证据1
PubMed2026年10月26日(insulin access OR insulin availability) AND "type 1 diabetes" AND (mortality OR "life expectancy") AND (Africa OR "low-income")反对性证据19
Europe PMC2026年10月26日TITLE:"type 1 diabetes" AND (TITLE:"global" AND TITLE:"mortality") AND PUB_YEAR:[2020 TO 2026]反对性证据10

核查深度如何？

13 项相关研究：4 项核查了全文（其中 1 项进行了结构化偏倚风险评估），9 项基于摘要核查，0 项仅核查了文献信息。 尚未进行由两名独立审查者完成的正式评估，也尚未进行独立的人类专家审核。

最近一次科学审核: 2026年10月26日

评定结论的变更历史
  1. 2026年10月25日 · 第 1 阶段 · 初始评估: 错误 (高)
  2. 2026年10月26日 · 第 4 阶段（系统证据审查） · 在扩展证据后重新审查；评定结论不变: 错误 (高)
    Insulin-omission data and natural history confirm the verdict; supervised deprescribing studies add a fair nuance for selected type 2 phenotypes.
    新来源: I-INS-101 I-INS-102 I-INS-108 I-INS-109 I-INS-128 I-INS-129 I-DIAB-105

通俗解释

这些视频展示了一些说自己停用胰岛素后感觉良好的人。这样的故事无法告诉我们有多少其他人因此生病。1型糖尿病患者没有胰岛素就会死亡。一些2型糖尿病患者在大幅减重后可以减少或停用药物，但这必须在医生指导下进行，并定期检查血糖。

与该说法相关的研究

支持该说法的研究 (1)

  • DiRECT: weight loss to put type 2 diabetes into remission

    Lean ME et al.. Lancet 2018 · PMID 29221645 · DOI 10.1016/S0140-6736(17)33102-1
    随机对照试验独立交叉核查已核查摘要★ 关键研究

    46% of people in the programme were free of diabetes and medication after one year.

    该研究是否支持这一具体说法？ 部分支持 · 方法学质量: 高 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Can intensive weight management in primary care achieve T2D remission?

    研究是如何开展的？

    Open-label cluster-randomised trial (DiRECT)

    研究了多少人、动物或样本？

    306 (149 per group ITT); 49 practices; Age 20-65, T2D <6 years, BMI 27-45, not on insulin

    实际发现了什么？

    Remission 46% vs 4%.

    观察到的效应有多大？

    OR 19.7

    研究结果对日常生活意味着什么？

    Losing 10-15 kg can reverse early type 2 diabetes.

    该研究有哪些局限？

    Open-label; Selected population; Formula diet

    它对 Elawady 的具体说法说明了什么？

    Supports C-DIAB-03 (with conditions); limited relevance to C-INS-10 (insulin users excluded).

    研究结果是否适用于德国和欧洲？

    UK; directly relevant.

    从该研究中明确不能得出什么结论？

    Effect of the Tayebat diet; effect in type 1 or insulin-treated diabetes.

    科学细节 →

与该说法相矛盾或限制该说法的研究 (8)

  • International guideline on diabetic ketoacidosis

    Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032
    指南 / 立场声明独立交叉核查已核查全文★ 关键研究

    Insulin, fluids and potassium are the core treatment; with this, fewer than 1% of adults die.

    该研究是否支持这一具体说法？ 否 · 方法学质量: 高 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Diagnosis and management of DKA and HHS in adults

    研究是如何开展的？

    International consensus report based on systematic examination of literature since 2009 (ADA, EASD, JBDS, AACE, DTS)

    研究了多少人、动物或样本？

    not applicable; Adults with diabetes

    实际发现了什么？

    Insulin is the cornerstone; glucocorticoids worsen hyperglycaemia.

    观察到的效应有多大？

    Mortality <1% with treatment

    研究结果对日常生活意味着什么？

    Ketoacidosis needs hospital treatment with insulin.

    该研究有哪些局限？

    Consensus, not trial

    它对 Elawady 的具体说法说明了什么？

    Directly contradicts C-INS-08; supports danger in C-FAST-03; contradicts C-INS-07, C-INS-10.

    研究结果是否适用于德国和欧洲？

    EASD and JBDS (UK) co-authored; directly applicable.

    从该研究中明确不能得出什么结论？

    Outcomes of untreated DKA quantitatively.

    科学细节 →

  • Review on diabetic ketoacidosis

    Dhatariya KK et al.. Nat Rev Dis Primers 2020 · PMID 32409703 · DOI 10.1038/s41572-020-0165-1
    叙述性综述独立交叉核查全文，含结构化偏倚风险评估

    DKA is an emergency that can kill; it is treated with fluids, insulin and salts, and insulin must not be stopped in type 1 diabetes even when not eating.

    该研究是否支持这一具体说法？ 否 · 方法学质量: 中 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Epidemiology, pathogenesis, diagnosis and management of DKA

    研究是如何开展的？

    Narrative expert review (Nature Reviews Disease Primers)

    研究了多少人、动物或样本？

    not applicable; Adults and children with diabetes

    实际发现了什么？

    DKA is diagnosed by high glucose, ketones and acid; it kills <1% when treated in rich countries but up to 26-41% where treatment is lacking; treatment is fluids, insulin and potassium, and insulin must never be stopped in type 1 diabetes even when not eating.

    观察到的效应有多大？

    not applicable

    研究结果对日常生活意味着什么？

    DKA is an emergency.

    该研究有哪些局限？

    Narrative expert review without systematic methods; one author has research support from insulin makers.

    它对 Elawady 的具体说法说明了什么？

    Contradicts C-INS-08, C-INS-02, C-FAST-01, C-FAST-03.

    研究结果是否适用于德国和欧洲？

    International.

    从该研究中明确不能得出什么结论？

    Quantitative estimates.

    科学细节 →

  • ADA guideline 2026: diabetes medicines

    American Diabetes Association Professional Practice Committee for Diabetes*. Diabetes Care 2026 · PMID 41358900 · DOI 10.2337/dc26-S009
    指南 / 立场声明独立交叉核查已核查全文★ 关键研究

    Insulin is essential in type 1 diabetes; SGLT2/GLP-1 drugs are recommended for heart and kidney protection; side effects listed.

    该研究是否支持这一具体说法？ 部分支持 · 方法学质量: 高 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Pharmacologic glycaemic treatment

    研究是如何开展的？

    Clinical practice guideline (ADA Standards of Care 2026, Section 9)

    研究了多少人、动物或样本？

    not applicable; People with type 1 and type 2 diabetes

    实际发现了什么？

    See results.

    观察到的效应有多大？

    not applicable

    研究结果对日常生活意味着什么？

    Medicines chosen by benefit-risk.

    该研究有哪些局限？

    Partially read

    它对 Elawady 的具体说法说明了什么？

    Contradicts C-INS-07, C-INS-10, C-ODD-06; supports C-ODD-07, C-INS-11.

    研究结果是否适用于德国和欧洲？

    Consistent with ADA/EASD consensus.

    从该研究中明确不能得出什么结论？

    Not applicable.

    科学细节 →

  • DCCT: better insulin treatment in type 1 diabetes

    Diabetes Control and Complications Trial Research Group; Nathan DM et al.. N Engl J Med 1993 · PMID 8366922 · DOI 10.1056/NEJM199309303291401
    随机对照试验独立交叉核查已核查摘要★ 关键研究

    Intensive insulin cut the risk of eye damage by three-quarters and nerve damage by 60%, with more low-sugar episodes.

    该研究是否支持这一具体说法？ 否 · 方法学质量: 高 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Does intensive insulin therapy reduce long-term complications in type 1 diabetes?

    研究是如何开展的？

    Multicentre RCT (DCCT)

    研究了多少人、动物或样本？

    1,441; Insulin-dependent (type 1) diabetes

    实际发现了什么？

    Large reductions in all microvascular complications.

    观察到的效应有多大？

    Retinopathy -76%

    研究结果对日常生活意味着什么？

    Insulin protects eyes, kidneys and nerves in type 1 diabetes.

    该研究有哪些局限？

    Open-label; Selected young population

    它对 Elawady 的具体说法说明了什么？

    Contradicts C-INS-07, C-INS-09, C-DIAB-01; shows insulin efficacy and hypoglycaemia cost (C-INS-02 kernel).

    研究结果是否适用于德国和欧洲？

    North American; universally accepted.

    从该研究中明确不能得出什么结论？

    Effects in type 2 diabetes directly.

    科学细节 →

  • Stopping insulin is the main cause of ketoacidosis in an urban US hospital

    Musey VC et al.. Diabetes Care 1995 · PMID 7497857 · DOI 10.2337/diacare.18.4.483
    病例系列 / 病例报告独立交叉核查已核查摘要★ 关键研究

    Two out of three ketoacidosis episodes in people with known diabetes followed stopping insulin.

    Insulin cessation caused two-thirds of DKA episodes in known diabetes.

    该研究是否支持这一具体说法？ 否 · 方法学质量: 低 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Find the causes of DKA.

    研究是如何开展的？

    Interviews and records of consecutive patients.

    研究了多少人、动物或样本？

    56 DKA episodes.

    实际发现了什么？

    Stopping insulin caused 67% of episodes in known diabetes.

    观察到的效应有多大？

    67% (95% CI about 52-79%).

    研究结果对日常生活意味着什么？

    Stopping insulin, even when not eating, can lead to ketoacidosis.

    该研究有哪些局限？

    Small, old, single centre.

    它对 Elawady 的具体说法说明了什么？

    Contradicts advice to treat or prevent DKA without insulin.

    研究结果是否适用于德国和欧洲？

    Mechanism universal; social reasons vary.

    从该研究中明确不能得出什么结论？

    Cannot give population rates.

    科学细节 →

  • Why people with diabetes end up in hospital with ketoacidosis again and again

    Randall L et al.. Diabetes Care 2011 · PMID 21775761 · DOI 10.2337/dc11-0701
    横断面研究独立交叉核查已核查摘要★ 关键研究

    In 164 adults admitted with ketoacidosis, stopping insulin was the main trigger in 68%.

    Stopping insulin leads to DKA.

    该研究是否支持这一具体说法？ 否 · 方法学质量: 中 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Find the drivers of recurrent DKA.

    研究是如何开展的？

    Bedside interviews.

    研究了多少人、动物或样本？

    164 adults.

    实际发现了什么？

    Insulin stopped in 68%.

    观察到的效应有多大？

    68% (about 60-74%).

    研究结果对日常生活意味着什么？

    Stopping insulin is dangerous.

    该研究有哪些局限？

    Single centre.

    它对 Elawady 的具体说法说明了什么？

    Contradicts insulin-free management of DKA.

    研究结果是否适用于德国和欧洲？

    Mechanism universal.

    从该研究中明确不能得出什么结论？

    Cannot give population incidence.

    科学细节 →

  • What happened to people with diabetes before insulin existed

    Mazur A. Nutr J 2011 · PMID 21396115 · DOI 10.1186/1475-2891-10-23
    叙述性综述独立交叉核查已核查全文★ 关键研究

    Before 1922, children with diabetes usually died of diabetic coma within months to a few years, even on strict fasting diets; some starved to death.

    Diet-only treatment of insulin-deficient diabetes led to death from coma or starvation.

    该研究是否支持这一具体说法？ 否 · 方法学质量: 低 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    To explain why fasting diets were used for diabetes before insulin and how patients fared.

    研究是如何开展的？

    Historical analysis of published case series and textbooks.

    研究了多少人、动物或样本？

    Patients of Allen (76 published cases) and Joslin, 1914-1922.

    实际发现了什么？

    Most children died of coma within months to years; 43% of Allen's cases were dead by 1917; four died of starvation; diabetes was not cured.

    观察到的效应有多大？

    43% mortality within a few years (Allen's series).

    研究结果对日常生活意味着什么？

    Diet and fasting alone cannot keep insulin-deficient diabetes alive; insulin changed this.

    该研究有哪些局限？

    Historical, uncontrolled data; diabetes types not distinguished.

    它对 Elawady 的具体说法说明了什么？

    Contradicts claims that diet can replace insulin or that ketoacidosis does not kill.

    研究结果是否适用于德国和欧洲？

    Universal biology.

    从该研究中明确不能得出什么结论？

    Cannot give exact survival curves or separate type 1 from type 2 cases.

    科学细节 →

  • How many people have type 1 diabetes worldwide and how long they live

    Gregory GA et al.. Lancet Diabetes Endocrinol 2022 · PMID 36113507 · DOI 10.1016/S2213-8587(22)00218-2
    其他独立交叉核查已核查摘要★ 关键研究

    About 8.4 million people had type 1 diabetes in 2021; a 10-year-old diagnosed in a low-income country could expect about 13 more years of life, versus 65 in a high-income country.

    Lack of insulin and care is associated with drastically shorter life expectancy.

    该研究是否支持这一具体说法？ 否 · 方法学质量: 中 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Estimate the global burden of type 1 diabetes.

    研究是如何开展的？

    Computer model fitted to registry and published data from many countries.

    研究了多少人、动物或样本？

    Model of 201 countries.

    实际发现了什么？

    8.4 million cases; 35,000 undiagnosed deaths within a year of symptoms; life expectancy gap 13 vs 65 years.

    观察到的效应有多大？

    Life expectancy difference about 52 years for a child diagnosed at 10.

    研究结果对日常生活意味着什么？

    Where insulin and care are hard to get, children with type 1 diabetes die young.

    该研究有哪些局限？

    Model estimates with uncertainty; funded by a T1D charity.

    它对 Elawady 的具体说法说明了什么？

    Contradicts 'type 1 does not exist' and any advice to stop insulin.

    研究结果是否适用于德国和欧洲？

    Europe is in the high-income group with long survival under insulin treatment.

    从该研究中明确不能得出什么结论？

    Cannot attribute individual deaths to specific causes.

    科学细节 →

结果不一或不明确的研究 (4)

  • Adding metformin to insulin

    Wulffelé MG et al.. Diabetes Care 2002 · PMID 12453950 · DOI 10.2337/diacare.25.12.2133
    随机对照试验被 Tayebat 档案网站引用已核查摘要

    Metformin improved sugar control and reduced insulin need and weight gain.

    该研究是否支持这一具体说法？ 是 · 方法学质量: 中 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Metformin added to intensive insulin in type 2 diabetes

    研究是如何开展的？

    Double-blind placebo-controlled RCT

    研究了多少人、动物或样本？

    390; Insulin-treated type 2 diabetes

    实际发现了什么？

    Better control, less insulin, less weight gain.

    观察到的效应有多大？

    GHb -0.7%

    研究结果对日常生活意味着什么？

    Combination lowers insulin needs.

    该研究有哪些局限？

    Short duration; Dropouts higher with metformin

    它对 Elawady 的具体说法说明了什么？

    Supports C-INS-11; context for C-INS-10.

    研究结果是否适用于德国和欧洲？

    Dutch data.

    从该研究中明确不能得出什么结论？

    That insulin can be stopped.

    科学细节 →

  • Who can stop insulin after a first episode of ketoacidosis?

    Raubenheimer PJ et al.. Diabetologia 2024 · PMID 38240751 · DOI 10.1007/s00125-023-06067-3
    队列研究独立交叉核查已核查摘要★ 关键研究

    In Cape Town, about a quarter of adults could stay off insulin for 5 years, mostly those with a type 2-like profile; people with type 1 antibodies rarely could.

    Some ketosis-prone T2D can come off insulin under supervision; antibody-positive (T1D) rarely.

    该研究是否支持这一具体说法？ 部分支持 · 方法学质量: 中 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Find predictors of insulin independence after DKA.

    研究是如何开展的？

    Prospective cohort with supervised weaning.

    研究了多少人、动物或样本？

    88 adults.

    实际发现了什么？

    46% at 1 year, 26% at 5 years off insulin; antibodies predict dependence.

    观察到的效应有多大？

    OR 11.5 (acanthosis); 0.10 (antibodies).

    研究结果对日常生活意味着什么？

    Stopping insulin is possible for some people with a specific type 2 profile, under medical supervision only.

    该研究有哪些局限？

    Small study.

    它对 Elawady 的具体说法说明了什么？

    Partly qualifies 'nobody can stop insulin'; contradicts stopping it in type 1.

    研究结果是否适用于德国和欧洲？

    Phenotype rarer in Europe.

    从该研究中明确不能得出什么结论？

    Cannot support stopping insulin without testing and supervision.

    科学细节 →

  • Supervised ketogenic diet programme in type 2 diabetes over 2 years

    Athinarayanan SJ et al.. Front Endocrinol (Lausanne) 2019 · PMID 31231311 · DOI 10.3389/fendo.2019.00348
    其他独立交叉核查已核查摘要★ 关键研究

    Many participants reduced or stopped diabetes medicines, including insulin, while doctors adjusted doses remotely; the study was not randomised.

    Insulin use fell 62% in T2D under physician-supervised ketogenic care; non-randomised; not T1D.

    该研究是否支持这一具体说法？ 部分支持 · 方法学质量: 低 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Evaluate a remote ketogenic-care programme.

    研究是如何开展的？

    Non-randomised trial.

    研究了多少人、动物或样本？

    349 adults with T2D.

    实际发现了什么？

    Insulin use -62%; remission 17.6%.

    观察到的效应有多大？

    Within-group changes.

    研究结果对日常生活意味着什么？

    Medicines can sometimes be reduced in type 2 diabetes, but only with medical supervision.

    该研究有哪些局限？

    Not randomised; sponsor.

    它对 Elawady 的具体说法说明了什么？

    Partly supports reduction of medication in T2D; not in T1D.

    研究结果是否适用于德国和欧洲？

    US programme.

    从该研究中明确不能得出什么结论？

    Cannot show safety of unsupervised stopping.

    科学细节 →

  • Ketoacidosis during very-low-carbohydrate diets

    Roberts CGP et al.. Diabetes Obes Metab 2025 · PMID 39996364 · DOI 10.1111/dom.16252
    队列研究独立交叉核查已核查摘要★ 关键研究

    DKA was rare (about 1 per 1000 patient-years in type 2 diabetes) in a supervised programme, but almost three times higher with SGLT2 inhibitors.

    Supervised low-carb programmes in T2D have low but real DKA rates; monitoring required.

    该研究是否支持这一具体说法？ 部分支持 · 方法学质量: 低 · 证据确定性：见该说法的总体评估

    原始文献 · 科学细节

    研究通俗解读
    研究人员想了解什么？

    Measure ketosis-related illness on ketogenic diets.

    研究是如何开展的？

    Retrospective programme data.

    研究了多少人、动物或样本？

    72,751 patient-years.

    实际发现了什么？

    DKA 1.01/1000 PY in T2D; 2.90 with SGLT2 inhibitors.

    观察到的效应有多大？

    Rates as reported.

    研究结果对日常生活意味着什么？

    Diet changes in diabetes need medical supervision and ketone checks.

    该研究有哪些局限？

    Programme data; no T1D.

    它对 Elawady 的具体说法说明了什么？

    Supports supervision and monitoring, not stopping medicines alone.

    研究结果是否适用于德国和欧洲？

    Applicable.

    从该研究中明确不能得出什么结论？

    Cannot address type 1 diabetes.

    科学细节 →

地区背景

德国 / 欧盟

European (EASD) and German (DDG) guidance follow the same evidence base as the ADA/EASD consensus: individualised HbA1c targets, insulin as mandatory therapy in type 1 diabetes, and SGLT2 inhibitors/GLP-1 receptor agonists for people with cardiovascular or kidney disease. No country-specific difference changes the assessment.

埃及

Egypt has one of the highest diabetes prevalences in the region; the same drug classes and insulins are used. Access barriers and cost may make advice to stop medication attractive, which increases the practical risk of this claim. No Egypt-specific evidence changes the assessment.

在我的国家适用什么？

一般科学评估

错误 自行停用胰岛素是危险的；任何减量都应在医疗监督下进行。

该说法涉及生物学或医学关系。上述科学评估不论在哪个国家都适用；各国食品数据不会改变这一评估。

参考文献

  1. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.. Lean ME et al.. Lancet 2018 · PMID 29221645 · DOI 10.1016/S0140-6736(17)33102-1
  2. Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.. Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032
  3. Diabetic ketoacidosis.. Dhatariya KK et al.. Nat Rev Dis Primers 2020 · PMID 32409703 · DOI 10.1038/s41572-020-0165-1
  4. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2026.. American Diabetes Association Professional Practice Committee for Diabetes*. Diabetes Care 2026 · PMID 41358900 · DOI 10.2337/dc26-S009
  5. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.. Diabetes Control and Complications Trial Research Group; Nathan DM et al.. N Engl J Med 1993 · PMID 8366922 · DOI 10.1056/NEJM199309303291401
  6. Diabetes in urban African-Americans. I. Cessation of insulin therapy is the major precipitating cause of diabetic ketoacidosis.. Musey VC et al.. Diabetes Care 1995 · PMID 7497857 · DOI 10.2337/diacare.18.4.483
  7. Recurrent diabetic ketoacidosis in inner-city minority patients: behavioral, socioeconomic, and psychosocial factors.. Randall L et al.. Diabetes Care 2011 · PMID 21775761 · DOI 10.2337/dc11-0701
  8. Why were "starvation diets" promoted for diabetes in the pre-insulin period?. Mazur A. Nutr J 2011 · PMID 21396115 · DOI 10.1186/1475-2891-10-23
  9. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study.. Gregory GA et al.. Lancet Diabetes Endocrinol 2022 · PMID 36113507 · DOI 10.1016/S2213-8587(22)00218-2
  10. Combination of insulin and metformin in the treatment of type 2 diabetes.. Wulffelé MG et al.. Diabetes Care 2002 · PMID 12453950 · DOI 10.2337/diacare.25.12.2133
  11. Phenotype and predictors of insulin independence in adults presenting with diabetic ketoacidosis: a prospective cohort study.. Raubenheimer PJ et al.. Diabetologia 2024 · PMID 38240751 · DOI 10.1007/s00125-023-06067-3
  12. Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial.. Athinarayanan SJ et al.. Front Endocrinol (Lausanne) 2019 · PMID 31231311 · DOI 10.3389/fendo.2019.00348
  13. Illnesses associated with ketosis including diabetic ketoacidosis during very low carbohydrate and ketogenic diets.. Roberts CGP et al.. Diabetes Obes Metab 2025 · PMID 39996364 · DOI 10.1111/dom.16252

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