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)

Abstract

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.

Reassessing type 2 diabetes in adolescents and its management strategies based on insulin resistance

“…The Japan Diabetes Data Management (JDDM74) analyzed data from over 4,000 patients over 30 years nationwide, with 3,454 patients achieving diabetes remission, significantly correlated with a moderate weight loss of 3.0–7.9% ( 108 ). Therefore, based on the current clinical characteristics achievable for diabetic patients, combined with ongoing interventional research, weight loss and subsequent visceral fat loss are crucial for relieving T2DM, with obesity being the central core for achieving remission.…”