Consensus report defines type 2 diabetes remission criteria
medwireNews: An international expert group organized by the ADA has published consensus definitions of type 2 diabetes remission.
The group included representatives from the ADA, EASD, Diabetes UK, the Endocrine Society, and the Diabetes Surgery Summit – plus an oncology expert – and the statement is published in the societies’ journals.
The expert group has adopted the term remission, defined as glycated hemoglobin (HbA1c) levels below 48 mmol/mol (6.5%) achieved at least 3 months after withdrawal of glucose-lowering medications.
The term remission “strikes an appropriate balance,” say Matthew Riddle (Oregon Health & Science University, Portland, USA) and statement co-authors, noting that while glucose levels can normalize, this may not be permanent and other abnormalities may remain.
“It is consistent with the view that a person may require ongoing support to forestall relapse, and regular monitoring to allow intervention should hyperglycaemia recur,” they write.
The group describes the chosen diagnostic HbA1c threshold “as generally reliable and the simplest and most widely understood defining criterion,” albeit noting that factors such as hemoglobin variants and certain disease states can make it occasionally less reliable.
In these circumstances, Riddle and colleagues advise continuous glucose monitoring indices as an alternative.
They avoid distinguishing between partial and complete remission, fearing this “could introduce ambiguity affecting policy decisions related to insurance premiums, reimbursements and coding of medical encounters.”
Remission can be diagnosed after metabolic/bariatric surgery, and where the improvement has resulted from lifestyle changes that remain ongoing, although they suggest a wait of 3 and 6 months, respectively, for glucose levels to stabilize in response to the intervention.
And the statement authors say that there must be a period of 3 months between withdrawal of glucose-lowering medications and diagnosis of remission. They stress this applies to all medications with an indication for glucose lowering, even if prescribed for other reasons (eg, glucagon-like peptide-1 receptor agonists for weight loss).
They also emphasize that remission may not last, so regular HbA1c checks are still required, and that complications relating to previous hyperglycemia may still appear even in the setting of sustained remission, so monitoring for retinopathy, nephropathy, neuropathy, and cardiovascular disease remains important.
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