Diabetes Remission Occurs in About 1-in-20, Scottish Study Finds

An analysis of more than 160,000 patients aged 30 years or older with type 2 diabetes is providing insight into contemporary trends in diabetes remission and factors associated with increased likelihood of achieving diabetes remission.

Results of the study, which suggest around 1-in-20 patients with diabetes were able to achieve remission, provide valuable insight to clinicians and providers as the obesity and diabetes epidemics continue to grow across the world.

“We have been able to show, for the first time, that 1 in 20 people in Scotland with type 2 diabetes achieve remission. This is higher than expected and indicates a need for updated guidelines to support clinicians in recognizing and supporting these individuals,” said lead investigator Mireille Captieux, MBChB, of the University of Edinburgh, in a statement.

As the prevalence of diabetes continues to grow, developing a greater understanding of factors associated with increased likelihood of remission and contemporary trends in the prevalence of remission stands to have a substantial impact on the lives of patients and health systems as a whole. With this in mind, Captieux and colleagues from the University of Edinburgh designed a cross-sectional study with the aim of estimating prevalence of remission among adults aged 30 years and older from within the Scottish Care Information-Diabetes (SCI-Diabetes) registry, which is a population-level registry with National Health System primary and secondary care data.

To limit the impact of changing diagnosis criteria, investigators only included patients with an HbA1c recording at or above 6.5% or 48 mmol/mol at some point from initial diagnosis to 2019. Ultimately, 162,316 patients were identified and met inclusion criteria for the primary analysis. The primary outcome of interest for the study was the remission of type 2 diabetes, which was assessed between January 1, 2019, and December 31, 2019. The criteria for remission of diabetes was an HbA1c below 6.5% to 48 mmol/mol in the absence of glucose-lowering therapy (GLT) for a continuous duration of 1 year or more from the time of diagnosis to the date of the last recorded HbA1c in 2019.

Investigators noted 56% of the 162,316-patient cohort were 65 years of age or older, 64% had diabetes for 6 years or longer, and the median BMI at diagnosis was 32.3 kg/m2. Investigators also pointed out 74% of the cohort was white and 19% of the cohort had missing ethnicity data.

Upon analysis, investigators identified 7710 (4.8%) patients meeting criteria for diabetes remission.Further analysis suggested multiple factors, including older age (OR, 1.48 [95% CI, 1.34-1.62]; P <.001), HbA1c below 48 mmol/mol at diagnosis (OR, 1.31 [95% CI, 1.24-1.39]; P <.001), no previous history of GLT (OR, 14.6 [95% CI, 13.7-15.5]; P <.001), weight loss from diagnosis to 2019 (OR, 4.45 [95% CI, 3.89-5.10]; P <.001), and previous bariatric surgery (OR, 11.9 [95% CI, 9.41-15.1]; P <.001).

Of note, the reduction in odds based on age was observed when comparing those aged 75s or older to the 45-54 years group, the reduction based on HbA1c was compared to those with an HbA1c of 48-52 mmol/mol at diagnosis, and the reduction based on weight loss was comparing those with a weight loss of 15 kg or more compared to those with a weight loss of 0-4.9 kg.

“Our findings provide a useful basis for the evaluation of the multifactorial approaches to both remission and prevention of diabetes that are currently being introduced and also highlight the need for guidelines to support definition of remission, management, and follow-up of people that achieve remission,” wrote investigators in their conclusion.

This study, “Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study,” was published in PLOS Medicine.