Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes

Riddle, Matthew C.; Cefalu, William T.; Evans, Philip; Gerstein, Hertzel C.; Nauck, Michael A.; Oh, William K.; Rothberg, Amy E.; Roux, Carel W. le; Rubino, Francesco; Schauer, Philip R.; Taylor, Roy; Twenefour, Douglas

doi:10.2337/dci21-0034

Cited by 252 publications

(164 citation statements)

References 38 publications

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“…Moreover, HbA1c alone is not always appropriate to diagnose diabetes, and, similarly, may not always be appropriate to diagnose remission, for example, for people with certain haemoglobinopathies or anaemia of chronic disease [ 8 , 29 ]. Other potential options include use of estimated HbA1c; however, this is not established in routine clinical settings [ 7 , 30 ]. This highlights the need for a definitive and comprehensive consensus on the definition of type 2 diabetes remission that is clear for people with type 2 diabetes and healthcare professionals in all settings [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…The IDF states that “remission is defined by most guidelines as an HbA1c below 6% (42 mmol/mol) without medication for 6 months or more” [ 5 ] (p. 21).” Buse and colleagues define remission as “achieving glycaemia below the diabetic range in the absence of active pharmacologic or surgical therapy.” Three types of remission are explicitly defined: partial remission, complete remission, and prolonged remission (cure) with a minimum duration of 1 year for partial and complete remission [ 6 ] (p. 2134). Riddle and colleagues define remission as “HbA1c <6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy” (p. 1) [ 7 ] (at least 6 months after starting a lifestyle intervention) [ 7 ]. We have previously shown that there were at least 96 unique definitions of diabetes remission used in the research literature from 2009 to 2020 [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study

et al. 2021

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Background Clinical pathways are changing to incorporate support and appropriate follow-up for people to achieve remission of type 2 diabetes, but there is limited understanding of the prevalence of remission in current practice or patient characteristics associated with remission. Methods and findings We carried out a cross-sectional study estimating the prevalence of remission of type 2 diabetes in all adults in Scotland aged ≥30 years diagnosed with type 2 diabetes and alive on December 31, 2019. Remission of type 2 diabetes was assessed between January 1, 2019 and December 31, 2019. We defined remission as all HbA1c values <48 mmol/mol in the absence of glucose-lowering therapy (GLT) for a continuous duration of ≥365 days before the date of the last recorded HbA1c in 2019. Multivariable logistic regression in complete and multiply imputed datasets was used to examine characteristics associated with remission. Our cohort consisted of 162,316 individuals, all of whom had at least 1 HbA1c ≥48 mmol/mol (6.5%) at or after diagnosis of diabetes and at least 1 HbA1c recorded in 2019 (78.5% of the eligible population). Over half (56%) of our cohort was aged 65 years or over in 2019, and 64% had had type 2 diabetes for at least 6 years. Our cohort was predominantly of white ethnicity (74%), and ethnicity data were missing for 19% of the cohort. Median body mass index (BMI) at diagnosis was 32.3 kg/m2. A total of 7,710 people (4.8% [95% confidence interval [CI] 4.7 to 4.9]) were in remission of type 2 diabetes. Factors associated with remission were older age (odds ratio [OR] 1.48 [95% CI 1.34 to 1.62] P < 0.001) for people aged ≥75 years compared to 45 to 54 year group), HbA1c <48 mmol/mol at diagnosis (OR 1.31 [95% CI 1.24 to 1.39] P < 0.001) compared to 48 to 52 mmol/mol), no previous history of GLT (OR 14.6 [95% CI 13.7 to 15.5] P < 0.001), weight loss from diagnosis to 2019 (OR 4.45 [95% CI 3.89 to 5.10] P < 0.001) for ≥15 kg of weight loss compared to 0 to 4.9 kg weight gain), and previous bariatric surgery (OR 11.9 [95% CI 9.41 to 15.1] P < 0.001). Limitations of the study include the use of a limited subset of possible definitions of remission of type 2 diabetes, missing data, and inability to identify self-funded bariatric surgery. Conclusions In this study, we found that 4.8% of people with type 2 diabetes who had at least 1 HbA1c ≥48 mmol/mol (6.5%) after diagnosis of diabetes and had at least 1 HbA1c recorded in 2019 had evidence of type 2 diabetes remission. Guidelines are required for management and follow-up of this group and may differ depending on whether weight loss and remission of diabetes were intentional or unintentional. Our findings can be used to evaluate the impact of future initiatives on the prevalence of type 2 diabetes remission.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study

et al. 2021

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“…By summer of 2020, she reported that her pain and headaches had improved, with an overall improvement in quality of life, as she was able to move around and exercise without pain or discomfort. In July of 2021, her fasting blood glucose was measured at 108 mg/dL and HbA1c was at 5.4%: she is no longer on any diabetes medications and meets the definition of diabetes remission [63].…”

Section: Case 2 321 Overview Of Conditionmentioning

confidence: 99%

Lifestyle Medicine and Economics: A Proposal for Research Priorities Informed by a Case Series of Disease Reversal

Livingston¹,

Freeman

Friedman

et al. 2021

IJERPH

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Chronic disease places an enormous economic burden on both individuals and the healthcare system, and existing fee-for-service models of healthcare prioritize symptom management, medications, and procedures over treating the root causes of disease through changing health behaviors. Value-based care is gaining traction, and there is a need for value-based care models that achieve the quadruple aim of (1) improved population health, (2) enhanced patient experience, (3) reduced healthcare costs, and (4) improved work life and decreased burnout of healthcare providers. Lifestyle medicine (LM) has the potential to achieve these four aims, including promoting health and wellness and reducing healthcare costs; however, the economic outcomes of LM approaches need to be better quantified in research. This paper demonstrates proof of concept by detailing four cases that utilized an intensive, therapeutic lifestyle intervention change (ITLC) to dramatically reverse disease and reduce healthcare costs. In addition, priorities for lifestyle medicine economic research related to the components of quadruple aim are proposed, including conducting rigorously designed research studies to adequately measure the effects of ITLC interventions, modeling the potential economic cost savings enabled by health improvements following lifestyle interventions as compared to usual disease progression and management, and examining the effects of lifestyle medicine implementation upon different payment models.

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“…Moreover, HbA1c alone is not always appropriate to diagnose diabetes, and, similarly, may not always be appropriate to diagnose remission, for example, for people with certain haemoglobinopathies or anaemia of chronic disease [8,29]. Other potential options include use of estimated HbA1c; however, this is not established in routine clinical settings [7,30]. This highlights the need for a definitive and comprehensive consensus on the definition of type 2 diabetes remission that is clear for people…”

Section: Plos Medicinementioning

confidence: 99%

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Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes

Cited by 252 publications

References 38 publications

Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study

Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study

Lifestyle Medicine and Economics: A Proposal for Research Priorities Informed by a Case Series of Disease Reversal

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