Remission can be achieved for a substantial number of patients with diabetes outside of clinical trials and without bariatric surgery, suggests new evidence

Diabetes drugs and equipment

 

One in 20 people with type 2 diabetes can achieve remission, suggest the findings of a new Scottish study published in PLoS Medicine.

While diabetes remission has been demonstrated in clinical trials and after bariatric surgery, this new research shows that remission can also be achieved for a substantial number of patients outside these settings.

This cross-sectional study estimated the prevalence of remission in all adults in Scotland aged 30 years or over diagnosed with type 2 diabetes and alive on 31 December 2019.

Remission, which was assessed between 1 January and 31 December 2019, was defined as all HbA1c values less than 48 mmol/mol in the absence of glucose-lowering therapy (GLT) for a continuous duration of 365 days or more before the date of the last recorded HbA1c in 2019.

The cohort consisted of 162,316 individuals who had at least one HbA1c of 48 mmol/mol or over (6.5%) at or after diagnosis of diabetes and at least one HbA1c recorded in 2019. More than half (56%) of participants were aged 65 years or over in 2019, and 64% had had type 2 diabetes for at least 6 years. Participants were predominantly of White ethnicity (74%). Median body mass index at diagnosis was 32.3 kg/m2.

Of the 162,316 patients eligible for the primary analysis, 7710 (4.8%; 95% confidence interval [CI], 4.7%–4.9%) were in remission in 2019.

Factors associated with remission were older age (odds ratio [OR], 1.48; 95% CI, 1.34–1.62; p<.001 for people aged ≥75 years compared with 45–54 years), HbA1c less than 48 mmol/mol at diagnosis (OR, 1.31; 95% CI, 1.24–1.39; p<.001; compared with 48–52 mmol/mol), no previous history of GLT (OR, 14.6; 95% CI, 13.7–15.5; p<.001), weight loss from diagnosis to 2019 (OR, 4.45; 95% CI, 3.89–5.10; p<.001, for ≥15 kg of weight loss compared with 0–4.9 kg weight gain), and previous bariatric surgery (OR, 11.9; 95% CI, 9.41–15.1; p<.001).

After stratification by age, the prevalence of remission in the study eligible population in 2019 was 3.2% in those aged under 64 years and 6.0% in those aged 65 years or over. The highest remission prevalence was in the over 75-year age group both before and after stratifying by sex and HbA1c at diagnosis. The highest prevalence of remission was observed in the over 75-year age group who had lost at least 15 kg since diagnosis of type 2 diabetes (14.5%).

Commenting on the findings, lead author Mireille Captieux, from the University of Edinburgh, said: ‘We have been able to show, for the first time, that one in 20 people in Scotland with type 2 diabetes achieve remission. This is higher than expected and indicates a need for updated guidelines to support clinicians in recognising and supporting these individuals.’

This article originally appeared on Univadis, part of the Medscape Professional Network.

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