Long‐term effects on glycaemic control and β‐cell preservation of early intensive treatment in patients with newly diagnosed type 2 diabetes: A multicentre randomized trial

Chon, Suk; Rhee, Sang Youl; Ahn, Kyu Joong; Baik, Sei Hyun; Park, Yong Soo; Nam, Moon Suk; Lee, Kwan Woo; Yoo, Soon Jib; Koh, Gwanpyo; Lee, Dong Hoon; Kim, Young Seol; Woo, Jeong-Taek; investigators, Kiit study

doi:10.1111/dom.13196

Cited by 21 publications

(13 citation statements)

References 33 publications

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“…We found a dose‐dependent association between the incidence of remission and BMI reduction regardless of baseline BMI, but this association was stronger with BMI of 27.5‐29.9 and slightly attenuated with BMI ≥30.0. This finding suggested that remission accompanied by weight loss may be achieved in patients with type 2 diabetes who have relatively mild increases in BMI through improvement in systemic inflammation, insulin resistance, β‐cell function 30–32 and fatty liver 33,34 in East Asians. The ORs for remission increased about two‐fold in those with 3.0‐6.9% BMI reductions than in those with changes in BMI <3%, suggesting that a relatively small weight loss may have a positive effect on remission of diabetes in Asians.…”

Section: Discussionmentioning

confidence: 98%

Relationship between the magnitude of body mass index reductions and remission in patients with type 2 diabetes in real world settings: Analysis of nationwide patient registry in Japan (JDDM74)

Fujihara,

Khin,

Murai

et al. 2023

Diabetes Obesity Metabolism

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AimsTo determine the association between the magnitude of weight loss and incidence of remission according to baseline characteristics in patients with diabetes in clinical settings.MethodsIn total, 39 676 Japanese patients with type 2 diabetes aged ≥18 years with glycated haemoglobin (HbA1c) ≥6.5% and/or glucose‐lowering drug prescription were identified from databases of specialists' clinics from 1989 and followed until September 2022. Remission was diagnosed as maintaining HbA1c <6.5% at least 3 months after cessation of a glucose‐lowering drug. Factors associated with remission were evaluated by logistic regression analysis according to weight change in 1 year (i.e. ≥10%, 7.0‐9.9%, 3.0‐6.9% reduction, <3% change and ≥3.0% increase).ResultsDuring the study period, 3454 remissions occurred. The rates of remission were higher in the group with the greatest reduction of body mass index (BMI) in any category examined (i.e. baseline BMI, HbA1c, duration of diabetes and treatment). The incidences of remission per 1000 person‐years were about 25 and 50, respectively, for those with BMI ≥22.5 and reductions in BMI of 7.0‐9.9% and ≥10% in 1 year. Remissions per 1000 person‐years were 99.2 and 91.8, respectively, for those with baseline HbA1c of 6.5‐6.9 and a 10% BMI reduction and those not taking glucose‐lowering drugs accompanied by a 10% BMI reduction.ConclusionsModest weight losses of 3.0‐7.9% were significantly associated with remission, but a minimum of 10% weight loss would be required in addition to an early diagnosis to achieve a 10% remission rate in clinical settings. Our results implied that remission may be expected with a relatively lower BMI in an Asian population compared with that was reported in Western populations if accompanied by weight loss.

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Section: Discussionmentioning

confidence: 98%

Relationship between the magnitude of body mass index reductions and remission in patients with type 2 diabetes in real world settings: Analysis of nationwide patient registry in Japan (JDDM74)

Fujihara,

Khin,

Murai

et al. 2023

Diabetes Obesity Metabolism

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“…Indeed, people with baseline HbA1c <7.0% have a shorter duration of diabetes than those with HbA1c of 7% to 9.9% (Table S4). Patients with newly diagnosed diabetes mellitus achieved remission with intensive treatment 5,36–41 . Early intensive therapies have had favourable outcomes on recovery and maintenance of β‐cell function 5,39 .…”

Section: Discussionmentioning

confidence: 99%

“…Patients with newly diagnosed diabetes mellitus achieved remission with intensive treatment. 5,[36][37][38][39][40][41] Early intensive therapies have had favourable outcomes on recovery and maintenance of β-cell function. 5,39 Therefore, screening of asymptomatic adults for type 2 diabetes may allow earlier detection, diagnosis and treatment.…”

Section: Person-years Was Approximately Twice As High In East Asian V...mentioning

confidence: 99%

Incidence and predictors of remission and relapse of type 2 diabetes mellitus in Japan: Analysis of a nationwide patient registry (JDDM73)

Fujihara,

Khin,

Murai

et al. 2023

Diabetes Obesity Metabolism

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Aims: To determine the incidence of remission and 1-year relapse from remission and associated factors in patients with type 2 diabetes.Materials and methods: A total of 48 320 Japanese patients with type 2 diabetes aged ≥18 years, with glycated haemoglobin (HbA1c) levels ≥48 mmol/mol (6.5%) and/or glucose-lowering drug prescription, were identified from databases of specialist clinics from 1989 and followed until September 2022. Remission was defined as HbA1c <48 mmol/mol at least 3 months after cessation of a glucose-lowering drug.Relapse was defined as failure to maintain remission for 1 year. Factors associated with remission and relapse were evaluated by logistic regression analysis. Results:The overall incidence of remissions per 1000 person-years was 10.5, and for those with HbA1c levels of 48 to 53 mmol/mol (6.5% to 6.9%), those taking no glucose-lowering drugs at baseline, and those with a ≥10% body mass index (BMI) reduction in 1 year, it was 27.8, 21.7 and 48.2, respectively. Shorter duration, lower baseline HbA1c, higher baseline BMI, higher BMI reduction at 1 year, and no glucose-lowering drugs at baseline were significantly associated with remission.Among 3677 persons with remission, approximately two-thirds (2490) relapsed within 1 year. Longer duration, lower BMI at baseline, and lower BMI reduction at 1 year were significantly associated with relapse. Conclusions:The results showed that the incidence of remission and predictors of relapse, especially baseline BMI, might differ greatly between East Asian and Western populations. Furthermore, the relationships of BMI reduction with remission and relapse may be greater in East Asian than in Western populations, implying ethnic differences in returning from overt hyperglycaemia to nearly normal glucose levels.

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“…In subsequent studies, randomized clinical trials were performed to compare conventional treatment and different insulin treatment methods, and status was evaluated to determine whether remission was reached ( Table 3 , Fig. 2 ) [ 50 - 54 ]. Remission following intensive insulin therapy has been demonstrated to last more than 2 years, and it is believed that the shorter the time interval between diagnosis and intensive insulin therapy is, the greater the likelihood of remission [ 10 ].…”

Section: Strategies For the Remission Of Type 2 Diabetes Mellitusmentioning

confidence: 99%

Not Control but Conquest: Strategies for the Remission of Type 2 Diabetes Mellitus

Kim

Kwon

2022

Diabetes Metab J

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A durable normoglycemic state was observed in several studies that treated type 2 diabetes mellitus (T2DM) patients through metabolic surgery, intensive therapeutic intervention, or significant lifestyle modification, and it was confirmed that the functional β-cell mass was also restored to a normal level. Therefore, expert consensus introduced the concept of remission as a common term to express this phenomenon in 2009. Throughout this article, we introduce the recently updated consensus statement on the remission of T2DM in 2021 and share our perspective on the remission of diabetes. There is a need for more research on remission in Korea as well as in Western countries. Remission appears to be prompted by proactive treatment for hyperglycemia and significant weight loss prior to irreversible β-cell changes. T2DM is not a diagnosis for vulnerable individuals to helplessly accept. We attempt to explain how remission of T2DM can be achieved through a personalized approach. It may be necessary to change the concept of T2DM towards that of an urgent condition that requires rapid intervention rather than a chronic, progressive disease. We must grasp this paradigm shift in our understanding of T2DM for the benefit of our patients as endocrine experts.

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Long‐term effects on glycaemic control and β‐cell preservation of early intensive treatment in patients with newly diagnosed type 2 diabetes: A multicentre randomized trial

Abstract: The findings indicate that outpatient clinic-based IIT to ensure euglycaemia in newly diagnosed patients with T2DM might be an effective initial therapeutic option for improvements in β-cell function and glycaemic control over the long term, without serious adverse events.

Cited by 21 publications

References 33 publications

Relationship between the magnitude of body mass index reductions and remission in patients with type 2 diabetes in real world settings: Analysis of nationwide patient registry in Japan (JDDM74)

Relationship between the magnitude of body mass index reductions and remission in patients with type 2 diabetes in real world settings: Analysis of nationwide patient registry in Japan (JDDM74)

Incidence and predictors of remission and relapse of type 2 diabetes mellitus in Japan: Analysis of a nationwide patient registry (JDDM73)

Not Control but Conquest: Strategies for the Remission of Type 2 Diabetes Mellitus

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