Diabetes remission achieved by about 5% of adults with type 2 diabetes
Click Here to Manage Email Alerts
Nearly 5% of adults aged 30 years or older diagnosed with type 2 diabetes between 2004 and 2018 in Scotland went on to achieve type 2 diabetes remission for at least 1 year, according to study findings published in PLOS Medicine.
“History of never having glucose-lowering therapy, weight loss since diagnosis, HbA1c < 6.5% at diagnosis, age 65 years and previous bariatric surgery are associated with remission,” Mireille Captieux, MBChB, MPH, a general practice clinical fellow at the Usher Institute, University of Edinburgh, Scotland, and colleagues wrote. “Our findings provide a useful basis for the evaluation of the multifactorial approaches to both remission and prevention of diabetes that are currently being introduced and also highlight the need for guidelines to support definition of remission, management and follow-up of people that achieve remission.”
Researchers conducted a cross-sectional population study of 162,316 adults aged 30 years or older diagnosed with type 2 diabetes between 2004 and 2018. Data were obtained from the Scottish Care Information-Diabetes registry. Diabetes remission was defined as having an HbA1c of less than 6% without glucose-lowering therapy for at least 1 year before the data of the last recorded HbA1c in 2019. Adults with at least one recorded HbA1c of 6.5% or higher after diagnosis and at least one reading in 2019 were included in the primary analysis.
Of the study cohort, 4.8% met the diabetes remission criteria in 2019. The proportion of people with diabetes remission increased slightly to 4.9% when the remission duration was reduced to 10 months.
Adults aged 65 to 75 years (OR = 1.2; 95% CI, 1.09-1.32; P < .001) or older than 75 years (OR = 1.48; 95% CI, 1.34-1.62; P < .001) in 2019 were more likely to achieve diabetes remission than those aged 45 to 54 years. Having an HbA1c of less than 6.5% at diabetes diagnosis was associated with greater odds for remission compared with those with a HbA1c between 6.5% and 6.9% (OR = 1.31; 95% CI, 1.24-1.39; P < .001), whereas those with an HbA1c of 7% or higher were less likely to achieve remission. Adults who were never prescribed glucose-lowering therapy had higher odds for diabetes remission than those prescribed therapy (OR = 14.57; 95% CI, 13.66-15.54; P < .001).
“The lack of history of glucose-lowering therapy prescription had a particularly strong association with remission,” the researchers wrote. “Glucose-lowering therapy is likely to be a marker for sustained hyperglycemia or higher levels of glycemia, but may also be an independent factor that decreases the risk of remission. Further research is required to investigate whether glucose-lowering therapy has a causal relationship with failure to achieve remission.”
Those who lost at least 5 kg of body weight were more likely to have diabetes remission than those who gained up to 5 kg of weight, with the highest odds for diabetes remission for those losing 15 kg or more (OR = 4.45; 95% CI, 3.89-5.1; P < .001). Adults who had bariatric surgery were more likely to achieve remission than those who never had surgery (OR = 11.93; (95% CI, 9.41-15.13; P < .001).
“Our results suggest that supporting clinicians to discuss remission and to refer to weight management services with early or diet-controlled diabetes is a rational approach,” the researchers wrote. “However, more data are needed to establish whether a very low-calorie diet approach will be effective or appropriate in people that have been excluded from trials. Our estimates for prevalence of type 2 diabetes remission reflect the period prior to the widespread introduction of the use of very low-calorie diets in routine clinical care and the COVID-19 pandemic, so further estimates of remission prevalence estimates will be required in the future.”
Collapse
Read more about
Click Here to Manage Email Alerts