medwireNews: Researchers have found evidence that almost one in 20 people diagnosed with type 2 diabetes in routine clinical care later achieve remission.
“Our prevalence estimates suggest that a reasonably large proportion of people achieve remission of type 2 diabetes in routine clinical care outside trial or bariatric surgery settings,” say Mireille Captieux (University of Edinburgh, UK) and study co-authors.
“The immediate implications for practice are that these people should be recognised and coded appropriately so they can be given adequate support and followed up to ensure continued care consistent with diabetes management guidelines.”
They stress: “It is important to recognise that remission of diabetes may not be permanent.”
The researchers’ analysis drew on data from a national diabetes registry covering almost all people resident in Scotland, aged at least 30 years, who received a type 2 diabetes diagnosis between 2004 and 2018. They defined remission as having all glycated hemoglobin (HbA1c) measurements below 48 mmol/mol (6.5%) in the absence of glucose-lowering medications for at least a year.
By this definition, 4.8% of 162,316 study participants with complete HbA1c data were in remission by the end of 2019. Sensitivity analyses also including people with incomplete HbA1c data (n=206,856 in total) gave remission estimates ranging from 3.7% to 9.9%.
Weight loss after diagnosis was an important independent predictor of remission, with its likelihood significantly increased starting at a weight loss of 5 kg and rising to a 4.45-fold increase at a weight loss of 15 kg or more.
Multivariable analysis also revealed the “unsurprising” finding that people with lower HbA1c levels at diagnosis and those never prescribed a glucose-lowering medication were significantly more likely to achieve remission than other participants.
People who underwent bariatric surgery had around a 12-fold increased likelihood for achieving remission, but the researchers note that this only applied to 488 people in their cohort, whereas the almost 31,000 people not taking glucose-lowering medications had nearly a 15-fold increased likelihood for remission.
“People who have not yet been prescribed drugs to treat diabetes may be the most appropriate group for clinicians to initiate discussions around remission and weight management options,” they write in PLOS Medicine.
Older people were more likely to achieve remission, specifically those aged 65 years or more when compared with those aged 45–54 years.
“Our findings suggest that people who were older than the age eligibility criteria for the DiRECT trial have the capacity to achieve remission of type 2 diabetes, although we were not able to establish whether weight loss was intentional or unintentional,” say Captieux and team.
They highlight the important distinction between these, noting that the association between remission and older age could have been partly driven by weight loss caused by comorbidities. However, they also suggest that older people could have been diagnosed at lower HbA1c values or BMIs than younger people, requiring only slight modification to achieve remission.
The team adds: “Clinicians also need greater clarity on how to manage older or frailer people who achieve remission criteria.”
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