Reversibility of diabetes mellitus: Narrative review of the evidence

Ang, Gary Yee

doi:10.4239/wjd.v9.i7.127

Cited by 16 publications

(11 citation statements)

References 39 publications

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“…The study presented here found that T2DM “remission” indeed occurs in Medicare patients 65 years and older who did not undergo bariatric surgery. These findings are consistent with previous findings and challenge the widespread notion that T2DM is irreversible in non-bariatric settings (13, 24, 25).…”

Section: Discussionsupporting

confidence: 92%

Type 2 Diabetes Mellitus (T2DM) “Remission” in Non-bariatric Patients 65 Years and Older

Tangelloju

Little

Esterhay

et al. 2019

Front. Public Health

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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.

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Section: Discussionsupporting

confidence: 92%

Type 2 Diabetes Mellitus (T2DM) “Remission” in Non-bariatric Patients 65 Years and Older

Tangelloju

Little

Esterhay

et al. 2019

Front. Public Health

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“…Hence, Abdelhafiz et al proposed that frailty among older people with type 2 diabetes might lead to the remission of type 2 diabetes with the suggested mechanisms being weight loss accompanied by reduced amounts of visceral fat and thereby improved insulin sensitivity 32 . Such a mechanism bears resemblance to that described for patients having bariatric surgery and/or substantial weight loss and afterwards experience remission of their type 2 diabetes 34,35 . www.nature.com/scientificreports www.nature.com/scientificreports/ We report that only 17% of included patients had an HbA 1c between 58-75 mmol/mol (7.5-9%), the interval generally recommended for elderly with significant comorbidities and limited life expectancy.…”

Section: Discussionmentioning

confidence: 67%

Glycemic control and use of glucose-lowering medications in hospital-admitted type 2 diabetes patients over 80 years

Gotfredsen

Vinther

Petersen

et al. 2020

Sci Rep

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Treatment guidelines for type 2 diabetes (T2D) recommend avoidance of hypoglycemia and less stringent glycemic control in older patients. We examined the relation of glycemic control to glucoselowering medications use in a cohort of patients aged>80 years with a diagnosis of T2D and a hospital admission in the Capital Region of Denmark in 2012-2016. We extracted data on medication use, diagnoses, and biochemistry from the hospitals' records. We identified 5,172 T2D patients with high degree of co-morbidity and where 17% had an HbA 1c in the range recommended for frail, comorbid, older patients with type 2 diabetes (58-75 mmol/mol (7.5-9%)). Half of the patients (n = 2,575) had an HbA 1c <48 mmol/mol (<6.5%), and a majority of these (36% of all patients) did not meet the diagnostic criteria for T2D. Of patients treated with one or more glucose-lowering medications (n = 1,758), 20% had HbA 1c -values <42 mmol/mol (<6%), and 1% had critically low Hba 1c values <30 mmol/mol (<4.9%), In conclusion, among these hospitalized T2D patients, few had an HbA 1c within the generally recommended glycemic targets. One third of patients did not meet the diagnostic criteria for T2D, and of the patients who were treated with glucose-lowering medications, one-fifth had HbA 1c -values suggesting overtreatment.For patients with type 2 diabetes, it is important to maintain blood glucose levels as close to normal as possible in order to reduce the risk of micro-and macrovascular complications 1-4 . Treatment should, however, be individualized according to comorbidities, disease duration, risk of adverse events and in particular hypoglycemia, life expectancy as well as the patient's own preferences, resources and support system 1 . Elderly people with type 2 diabetes will generally have co-existing illness and relatively few resources 5 . Life expectancy will often be shorter than the time it takes for micro-and macrovascular disease complications to develop and manifest 6,7 . This is in contrast to the potential adverse effects of glucose-lowering medications that often appear in the short term. Hypoglycemia is the most important example of an acute and potentially fatal adverse effect to which elderly are particularly vulnerable [8][9][10][11][12][13][14][15] . Less effective counterregulatory mechanisms, decreased drug elimination, motor and cognitive impairment as well as unspecific/uncharacteristic symptoms all contribute to the heightened risk in elderly patients 16 . Thus, the overall goal with treatment individualization should be to weigh the typically long-term benefits vs. therapy burden and risk of adverse events on the shorter term 7,15,17,18 . Available evidence from the few clinical trials enrolling elderly patients with type 2 diabetes support that the benefits of intensive glycemic control targeting near-normal glycemia may not outweigh potential risks in this population 8,[19][20][21][22] . This is also reflected in several international guidelines which generally advocate a less stringent treatment approach for older ...

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“…Prior diabetes reversal studies have primarily defined reversal as a binary event that is reached when patients eliminate antidiabetic medications and maintain HbA1c < 5.7% for a year [ 3 , 6 – 9 , 14 , 15 ]. In the Diabetes Remission Clinical Trial (DiRECT), Lean et al found that 46% of patients in a year-long weight management program achieved diabetes remission (HbA1c < 6.5% at least 2 months after discontinuing all antidiabetic medications) [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…In his review of the evidence for reversibility of diabetes [ 15 ], Ang cited the need for additional research into the subgroups of diabetes patients for whom reversal would be feasible and specifically mentioned the need for research in non-obese patients as well as the SIDD, SIRD, MOD, and MARD subgroups. The current study provides evidence that reversal progression can occur, particularly in the MARD, MOD, and SIRD clusters.…”

Section: Discussionmentioning

confidence: 99%

Type 2 diabetes reversal with digital twin technology-enabled precision nutrition and staging of reversal: a retrospective cohort study

Shamanna¹,

Joshi²,

Shah³

et al. 2021

Clin Diabetes Endocrinol

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Background Type 2 diabetes reversal has been viewed in the literature primarily as a dichotomous event (reversed or not reversed), even though this viewpoint may not be optimal for clinicians or patients. This cohort study’s objectives were to define stages of type 2 diabetes reversal and measure changes in reversal stages before and after 90 days of digital twin-enabled precision nutrition therapy. Methods This study defines seven stages of diabetes reversal. The study is a retrospective pre/post comparison of changes in reversal stage, hemoglobin A1c (HbA1c), weight, body mass index (BMI), and other metrics measured before and after precision nutrition therapy. Reversal stages were defined as Stage 0: HbA1c < 5.7% without medication for > 1 year, Stage 1: HbA1c < 5.7% without medication for < 1 year, Stage 2: HbA1c < 6.5% without medication, Stage 3: estimated HbA1c (eA1c) between 5.7 and 6.4% without medication, Stage 4: estimated HbA1c (eA1c) between 5.7 and 6.4% with metformin monotherapy, Stage 5: dual oral therapy, Stage 6: > = 3 medications. Results Reversal stage information was available for 463 patients at baseline and 90 days. At baseline, the proportions of patients in each reversal stage were Stages 1 and 2: 0%, Stage 3: 1%, Stage 4: 8%, Stage 5: 6%, and Stage 6: 85%. After 90 days, the proportions in each reversal stage were Stage 1: 2%, Stage 2: 9%, Stage 3: 32%, Stage 4: 39%, Stage 5: 7%, and Stage 6: 11%, indicating significant progress. Reversal stage progression rates varied by patient subgroup. Conclusions Type 2 diabetes patients reached differing reversal stages during 90 days of precision nutrition therapy. Use of reversal stages may benefit patients during therapy. Trial registration This was a retrospective study that was approved by the Medisys Clinisearch Ethical Review Board (without registration number) in 2019.

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Reversibility of diabetes mellitus: Narrative review of the evidence

Cited by 16 publications

References 39 publications

Type 2 Diabetes Mellitus (T2DM) “Remission” in Non-bariatric Patients 65 Years and Older

Type 2 Diabetes Mellitus (T2DM) “Remission” in Non-bariatric Patients 65 Years and Older

Glycemic control and use of glucose-lowering medications in hospital-admitted type 2 diabetes patients over 80 years

Type 2 diabetes reversal with digital twin technology-enabled precision nutrition and staging of reversal: a retrospective cohort study

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