Objective: To analyze the factors associated with type 2 diabetes mellitus (T2DM) “remission” in non-bariatric Medicare patients 65 years and older. Research Design and Methods: A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if the individual had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in “remission” if they had no T2DM related claims for more than 12 months continuously. This is different from the standard American Diabetes Association (ADA) definition of remission which includes HbA1c values and hence is represented in quotation (as “remission”). 10,059 T2DM individuals were evaluated over a period of 8 years from 2008 to 2015. Cox proportional hazards was used to identify significant variables associated with T2DM “remission.” Results: 4.97% of patients studied met the definition of T2DM “remission” in the study cohort. After adjusting for covariates this study found a number of variables associated with T2DM “remission” that were not previously reported: no statin use; low diabetes complications severity index score; no hypertension; no neuropathy; no retinopathy; race (non-white and non-African American); presence of other chronic ischemic heart disease (IHD) and females ( p < 0.05). Conclusion: T2DM “remission” in Medicare patients 65 years and older is observed in a community setting in a small proportion of non-bariatric patients.

Background To evaluate the association of statins and co‐morbidities with new onset type 2 diabetes mellitus (T2DM) in patients 65 years and older. Methods This retrospective study used de‐identified administrative healthcare claims and enrolment data from a Medicare Advantage Prescription Drug (MAPD) health plan offered by a large multistate healthcare company. The plan covered >2.4 million individuals, of whom >1.7 million individuals were ≥65 years. Of these, 265 554 individuals had continuous MAPD enrolment January 2008 to December 2015. The unadjusted model assessed demographic, pharmacy and T2DM co‐morbidities as covariates. Significant variables (P < .05) in the unadjusted model were then included in the adjusted model. The adjusted model used Cox proportional hazards to evaluate covariate effects. Matched propensity score analysis was used to analyse the association of statins and T2DM onset. Results The cumulative rate of diagnosed T2DM onset in the study cohort was 4.82% (4314/89 390). Annualised incidence of T2DM diagnosis was 0.82%, 0.88%, 1.04% and 2.09% in 2012, 2013, 2014 and 2015, respectively. T2DM onset was associated with male sex, non‐white (African American or Hispanic ethnicity), statin use, hypertension, hyperlipidaemia, heart failure, lower limb ulceration, atherosclerosis, other retinopathy, angina pectoris, poor vision and blindness and absence ischaemic heart disease (IHD). Matched propensity score analysis showed that statin use was significantly associated with T2DM onset (Odds Ratio = 1.26, 95% Confidence Interval: 1.12‐1.41, P < .0001) in the adjusted model. Conclusions Analyses indicated that statin usage was associated with new onset T2DM after adjusting for covariates.

Objective: To analyze the characteristics of individuals who went into remission for type 2 diabetes mellitus (T2DM) in the absence of bariatric surgery in three large population level datasets. Methods: Data from three large T2DM cohorts were used in this analysis: a) 10,059 subjects from a longitudinal Medicare cohort (n=2.4 Million); b) 4,997 subjects, Continuous NHANES (n=82,091); and c) 562 subjects, NHANES III (n=33,994). A Medicare T2DM individual with no T2DM related claims continuously for more than 12 months was considered to be in remission. In the NHANES data T2DM remission was defined as an HbA1c ≤ 5.7 without T2DM related medications. Cox proportional hazards was used to identify significant variables associated with T2DM “remission” in the Medicare data. NHANES data were analyzed with multiple logistic regression with T2DM remission as the dependent variable. Results: In the Medicare dataset 4.97% met the criteria for T2DM remission in a five-year longitudinal study, while 2.76% and 1.97% of the continuous NHANES and the NHANES III subjects, respectively, achieved remission in the cross-sectional cohorts. The factors associated with T2DM remission were no statin use; no insulin use; no hypertension; no hyperlipidemia; no neuropathy; no retinopathy; female gender; non-African American ethnicity; decreased waist circumference and lower systolic blood pressure (Bonferroni adjusted p≤0.05). The rate of T2DM remission appears to be approximately 1.97 to 4.97%. Conclusions: T2DM remission triggers exist (Lancet, Dec 2017). Of the factors associated with T2DM remission, only ethnicity and gender are non-modifiable risk factors. Therefore, diabetes prevention and management programs should concentrate on lowering body weight, lipids, and blood pressure. Management of these factors is associated with T2DM remission. Identification of other factors associated with T2DM may lead to more efficacious programmatic management of the disease and attenuation of serious co-morbidities. Disclosure S. Tangelloju: Employee; Self; Humana Inc.. G. Vu: None. H. Chavis-Blakely: None. B.B. Little: None.

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