Incidence and characteristics of remission of type 2 diabetes in England: A cohort study using the National Diabetes Audit

Objective: To assess the incidence of remission of type 2 diabetes in routine care settings.
Research design and methods: People with type 2 diabetes (HbA1c ≥48 mmol/mol (6·5%) or <48 mmol/mol (6·5%) with a prescription for glucose lowering medications) alive on 1st April 2018 were identified from a national collation of health records in England and followed until 31st December 2019. Remission was defined as two HbA1c measurements <48 mmol/mol at least 182 days apart, with no prescription for glucose lowering medications 90 days prior to these measurements.
Results: In 2,297,700 people with type 2 diabetes the overall incidence of remission per 1000 person-years was 9·7 (95% CI 9·6-9·8), and 44·9 (95% CI 44·0-45·7) in 75,610 (3.3%) people who were diagnosed less than a year. In addition to shorter duration of diagnosis, baseline factors associated with higher odds of remission were no prescription for glucose lowering medication, lower HbA1c and BMI, BMI reduction, White ethnicity, female sex and lower socio-economic deprivation. Among 8940 (0.4%) with characteristics associated with remission (diagnosed less than two years, HbA1c <53 mmol/mol, prescribed metformin alone or no glucose lowering medications, BMI reduction of ≥10%) incidence of remission was 83·2 (95% CI 78·7-87·9) per 1000 person-years.
Conclusions: Remission of type 2 diabetes was generally infrequent in routine care settings but may be a reasonable goal for a subset of people who loose significant weight shortly after diagnosis. Policies that encourage intentional remission of type 2 diabetes should seek to reduce the ethnic and socioeconomic inequalities identified.