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 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 31/12/2019. Remission of type 2 diabetes was assessed between 1/1/2019 and 31/12/2019. We defined remission as all HbA1c values <48mmol/mol in the absence of glucose lowering treatment 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 one HbA1c >48mmol/mol (6.5%) at or after diagnosis of diabetes and at least one 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 BMI at diagnosis was 32.3kg/m2. 7,710 people (4.8% [95% CI 4.7-4.9%]) were in remission of type 2 diabetes. Factors associated with remission were: older age (OR 1.48 [95% CI 1.34-1.62] P<0.001) for people aged >75 years compared to 45-54 year group), HbA1c <48mmol/mol at diagnosis (OR 1.31 [95%CI 1.24-1.39] P<0.001) compared to 48-52mmol/mol), no previous history of glucose lowering therapy (OR 14.6, [95%CI 13.7-15.5] P<0.001), weight loss from diagnosis to 2019 (OR 4.45 [95%CI 3.89-5.10] P<0.001) for >15kg of weight loss compared to 0-4.9kg weight gain) and previous bariatric surgery (OR 11.9 [95%CI 9.41-15.1] P<0.001). Limitations of the study include use of 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 one HbA1c >48mmol/mol (6.5%) after diagnosis of diabetes and had at least one 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 was intentional or unintentional. Our findings can be used to evaluate the impact of future initiatives on the prevalence of type 2 diabetes remission.
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 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 31/12/2019. Remission of type 2 diabetes was assessed between 1/1/2019 and 31/12/2019. We defined remission as all HbA1c values <48mmol/mol in the absence of glucose lowering treatment 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 one HbA1c >48mmol/mol (6.5%) at or after diagnosis of diabetes and at least one 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 BMI at diagnosis was 32.3kg/m2. 7,710 people (4.8% [95% CI 4.7-4.9%]) were in remission of type 2 diabetes. Factors associated with remission were: older age (OR 1.48 [95% CI 1.34-1.62] P<0.001) for people aged >75 years compared to 45-54 year group), HbA1c <48mmol/mol at diagnosis (OR 1.31 [95%CI 1.24-1.39] P<0.001) compared to 48-52mmol/mol), no previous history of glucose lowering therapy (OR 14.6, [95%CI 13.7-15.5] P<0.001), weight loss from diagnosis to 2019 (OR 4.45 [95%CI 3.89-5.10] P<0.001) for >15kg of weight loss compared to 0-4.9kg weight gain) and previous bariatric surgery (OR 11.9 [95%CI 9.41-15.1] P<0.001). Limitations of the study include use of 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 one HbA1c >48mmol/mol (6.5%) after diagnosis of diabetes and had at least one 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 was intentional or unintentional. Our findings can be used to evaluate the impact of future initiatives on the prevalence of type 2 diabetes remission.
| Original language | English |
|---|---|
| Journal | PLoS Medicine |
| DOIs | |
| Publication status | Published - 2 Nov 2021 |