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

Abstract

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.

Nonalcoholic fatty liver disease in relation to the remission and progression along the glycemic continuum

“…However, how common the remission of T2D was among the general population remained poorly reported. A cohort investigation from Scotland estimated 4.8% of the prevalence of T2D remission in 2019 among 162 316 national T2D register 18 . The study further summarized that participants in remission tended to be older, have a lower HbA1c at diagnosis, with no history of antidiabetic prescription, succeed in any weight loss from diagnosis, and have had previous history of bariatric surgery, comparing to participants who did not achieve remission, which were coincided with experience from previous intervention studies 19,20 .…”

“…A cohort investigation from Scotland estimated 4.8% of the prevalence of T2D remission in 2019 among 162 316 national T2D register. 18 The study further summarized that participants in remission tended to be older, have a lower HbA1c at diagnosis, with no history of antidiabetic prescription, succeed in any weight loss from diagnosis, and have had previous history of bariatric surgery, comparing to participants who did not achieve remission, which were coincided with experience from previous intervention studies. 19,20 Therefore, ascertainment of those characteristics contributed to the identification of individuals with T2D who were most likely to achieve and maintain remission, which was important for making informed decisions regarding relevant T2D management and intervention.…”

Long-term remission of type 2 diabetes after very-low-calorie restriction and related predictors

“…Partial studies have shown that weight loss could induce T2DM remission in a dose-dependent manner ( 9 , 10 , 18 , 19 ). However, in our study, the body weight changes during VLCR did not differ significantly between the two groups, which is consistent with the results from DiRECT sub-study ( 15 ).…”

“…The long-term remission rate of T2DM after VLCR has been investigated. A cross-sectional study from Scotland in 2019 reported that 4.8% of patients with T2DM achieved remission, manifested as HbA1c < 6.5% in the absence of glucose-lowering therapy for at least 12 months ( 9 ). A 2-year remission rate of 35.6% after VLCR was achieved in the Diabetes Remission Clinical Trial (DiRECT), which performed the longest follow-up for analyzing T2DM remission ( 10 ).…”

The Role of Beta Cell Recovery in Type 2 Diabetes Remission

“…This improvement in glucose levels back to a normal or near-normal interval can be achieved by lifestyle changes or following a number of interventions [13,14]. A recent observational study in 162,316 T2D subjects reports that remission occurred in 5% of cases, and that factors associated with remission were older age, HbA1c < 48 mmol/mol (6.5%) at diabetes diagnosis, no previous history of glucoselowering therapy, weight loss and bariatric surgery [15]. [13,14]).…”