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

Abstract

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.

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)

“…Similarly, in the Delivering the Diabetes Remission Clinical Trial (DiRECT), intervention in early‐stage obese patients with type 2 diabetes was shown to result in the achievement of remission in about half 20 . In our previous study, there was a strong association between body mass index (BMI) reductions over 1 year and remission of diabetes in the analysis of a nationwide patient registry in Japan 6 . Holman et al also reported the same association between body weight reduction and remission in UK, 2 suggesting no ethnic differences in this relationship.…”

“…In a meta‐analysis of trials of short‐term intensive insulin therapy, two‐thirds of participants achieved remission, but about one‐third relapsed after 12 months 27 . In cohort studies, the same phenomenon was observed 2 and relapse of remission of diabetes occurred in two‐thirds of participants within 1 year 6 . However, few studies have evaluated long‐term remissions in real world settings using consensus definitions for various aspects of diabetes and its remission.…”

“…[2][3][4][5][6] In fact, the overall incidence of remission was only about 10 per 1000 personyears regardless of race in a community setting. 2,6 As the rate of remission of diabetes because of non-surgical therapy was much lower than that of metabolic surgery, [7][8][9][10] it is necessary to identify groups with a high chance of remission and provide interventions.…”

“…27 In cohort studies, the same phenomenon was observed 2 and relapse of remission of diabetes occurred in two-thirds of participants within 1 year. 6 However, few studies have evaluated long-term remissions in real world settings using consensus definitions for various aspects of diabetes and its remission.…”

“…Remission, which is defined as the improvement in the glucose level to a normal range and cessation of the need for medication in patients diagnosed with type 2 diabetes, 1 was reported to have a relatively low frequency in both Western countries and East Asia 2–6 . In fact, the overall incidence of remission was only about 10 per 1000 person‐years regardless of race in a community setting 2,6 .…”