Incidence and Characteristics of Remission of Type 2 Diabetes in England: A Cohort Study Using the National Diabetes Audit

Holman, Naomi; Wild, Sarah; Khunti, Kamlesh; Knighton, Peter; OʼKeefe, Jackie; Bakhai, Chirag; Young, Bob; Sattar, Naveed; Valabhji, Jonathan; Gregg, Edward W.

doi:10.2337/dc21-2136

Cited by 28 publications

(46 citation statements)

References 17 publications

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“…16 In a previous analysis of the incidence of remission of type 2 diabetes using NDA data showed that short‐term relapse to diabetic hyperglycaemia was approximately 9% over a median of 190 days. 17 This highlights the importance of ongoing diabetes‐related care delivery to identify a potential relapse and future macro and microvascular risk for those achieving remission.…”

Section: Discussionmentioning

confidence: 99%

Care processes in people in remission from type 2 diabetes: A cohort study using the National Diabetes Audit

et al. 2022

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Aims: People with type 2 diabetes can enter remission but may relapse or develop legacy complications. This analysis assesses whether people with remission from type 2 diabetes continue receiving annual care processes recommended in national guidelines and potential impacts of formal recognition of remission.Methods: People with type 2 diabetes with and without formal recognition (diagnostic code) of remission, and with and without evidence of remission (HbA1c<48 mmol/mol without prescription for glucose-lowering drugs in preceding 26 weeks), included in the 2018/19 National Diabetes Audit (NDA) for England and Wales were followed up to identify care processes received between 1 st January 2019 and 31 st March 2020.Results: Of the 2,822,145 people with type 2 diabetes in the cohort, 16,460 (0.58%) were coded with remission in the 2018/19 NDA. After adjustment for age, sex, socioeconomic deprivation and ethnicity, people coded with remission were less likely to receive each care process than those without such coding irrespective of HbA1c measurements (relative risk (RR) of receiving all 8 care processes 0.70 (95% CI 0.69-0.72)). For the 339,235 people with evidence of remission irrespective of diagnostic coding compared to those without such evidence the RR for receiving all 8 care processes was 0.94 (95% CI 0.93-0.94). Conclusions:People coded with remission of type 2 diabetes were less likely to receive diabetes care processes than those without such coding. People with evidence of remission had only slightly reduced likelihood of receiving care processes. Formal recognition of remission may affect provision or uptake of care processes.

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Section: Discussionmentioning

confidence: 99%

Care processes in people in remission from type 2 diabetes: A cohort study using the National Diabetes Audit

et al. 2022

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“…Clinical trials have shown that weight loss ≥ 15% is necessary in the first years of T2D diagnosis to achieve disease remission [24,25]. Nevertheless, the incidence of T2D remission in routine care settings is infrequent (< 1%) [30], in particular in patients with depressive symptoms [31]. Indeed, depression favors weight gain and determines a 60% increased risk of developing T2D [32][33][34] directly through three of its symptoms that we have re-named Bridge Symptoms (BS): alteration of eating behavior [35,36], reduced physical activity [37,38] and inadequate sleep duration [39,40].…”

Section: Discussionmentioning

confidence: 99%

“…Performing psychiatric screening in patients with T2D is needed to intercept cases of mental disorder that might otherwise remain unknown and to intervene on the development of T2D and its remission, considering how CPDs favor its onset and maintenance [17,30,42]. This could help reduce the T2D epidemic, driving a reduction in Years of Life Lost (YLL) given that Diabetes is the 9th cause of death worldwide, and it is an important contributing cause to the first and second cause of death globally (ischemic heart disease and stroke).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the prevalence of the most common psychiatric disorders in patients with type 2 diabetes mellitus using the patient health questionnaire: results of the cross-sectional “DIA2PSI” study

et al. 2022

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Aims Common Psychiatric Disorders (CPDs) are associated with the development of overweight and obesity, the strongest risk factors for the onset and maintenance of Type 2 Diabetes mellitus (T2D). To the best of our knowledge, this is the first study to assess the prevalence of CPDs in patients with T2D in Italy. Methods This is a monocentric cross-sectional study; n = 184 T2D patients were screened for CPDs using the Patient Health Questionnaire (PHQ). Primary outcome was to evaluate the prevalence of CPDs. To assess association between CPDs and risk factors, we have utilized univariable logistic regression models. Results 64.1% were men, median age was 67 (59–64) and median BMI 27 (25–30) kg/m2. The 42.9% tested positive for one or more mental disorders, 25.6% for depression. Patients with higher BMI (p = 0.04) had an increased likelihood of testing positive to the PHQ. Patients who had implemented lifestyle changes (p < 0.01) and were aware that mental health is linked to body health (p = 0.07) had a reduction in the likelihood of testing positive. Conclusions Prevalence of CPDs in T2D patients is higher than in the general population. Since CPDs favor the onset and subsistence of T2D, integrated diabetic-psychiatric therapy is required for improvement or remission of T2D in patients with comorbid CPDs.

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“…We used the 10% cutoff because there is a sharp cut‐off in percentage of people achiving remission above and below this point. 15 , 16 Mixed‐effects ANOVAs with a random person‐effect were undertaken to assess the within‐subject effect of ‘time’ (baseline, 12 month, 24 month), the between‐subject effect of weight loss (<10% or ≥ 10%), and any interaction effects. Between weight loss group estimates (β), 95% CI and p‐ values were recorded for each variable.…”

Section: Methodsmentioning

confidence: 99%

Physical activity, inactivity and sleep during the Diabetes Remission Clinical Trial (DiRECT)

et al. 2022

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Aims:As sustained weight loss is vital for achieving remission of type 2 diabetes, we explored whether randomisation to weight loss plus maintenance in the DiRECT trial was associated with physical activity, inactivity or sleep.Methods: Participants were randomised to either a dietary weight management programme or best-practice care. The weight management group were encouraged to increase daily physical activity to their sustainable maximum. Objective measurement was achieved using a wrist-worn GENEActiv accelerometer for 7 days at baseline, 12 and 24 months in both groups.Results: Despite average weight loss of 10 kg at 12 months in the intervention (n = 66) group, there were no differences in total physical activity or inactivity compared with the control (n = 104) at any time point. However, in our exploratory analysis, those who lost more than 10% of their baseline body weight performed on average 11 mins/day more light activity than the <10% group at 24 months (p = 0.033) and had significantly lower bouts of Inactivity 30min (interaction, p = 0.005) across 12 and 24 months. At 24 months, the ≥10% group had higher daily acceleration (38.5 ± 12.1 vs. 33.2 ± 11.1 mg, p = 0.020), and higher

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Incidence and Characteristics of Remission of Type 2 Diabetes in England: A Cohort Study Using the National Diabetes Audit

Cited by 28 publications

References 17 publications

Care processes in people in remission from type 2 diabetes: A cohort study using the National Diabetes Audit

Care processes in people in remission from type 2 diabetes: A cohort study using the National Diabetes Audit

Evaluation of the prevalence of the most common psychiatric disorders in patients with type 2 diabetes mellitus using the patient health questionnaire: results of the cross-sectional “DIA2PSI” study

Physical activity, inactivity and sleep during the Diabetes Remission Clinical Trial (DiRECT)

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