Remission rates of 1 in 100 people with type 2 diabetes in real world data

Newswise — Niigata, Japan - The occurrence of normalizing glucose levels and discontinuation of medication can manifest in certain individuals diagnosed with type 2 diabetes who receive lifestyle therapy, short-term pharmacotherapy, bariatric surgery, or various combinations of these interventions. Nevertheless, comprehending this occurrence completely in everyday care settings is still lacking, and numerous aspects necessitate further elucidation. Furthermore, given the disparities in insulin secretion and resistance between East Asian and Western communities, the progression of diabetes appears to diverge significantly between Western populations and East Asians.

Hence, these concerns prompted Dr. Kazuya Fujihara and colleagues to investigate the occurrence of relapse within a year after remission and the associated factors in patients diagnosed with type 2 diabetes. In their paper for Diabetes, Obesity and Metabolism, the researchers examined these research inquiries utilizing a database of specialized clinics. They scrutinized data from the Japan Diabetes Clinical Data Management Study Group (JDDM), which constitutes one of the largest groups of Japanese individuals with type 2 diabetes. They monitored information concerning 48,320 diabetes patients in Japan. Within one segment of the study, remission rates per 1000 person-years were computed. The authors stated a median follow-up period of 5.3 years. Over the course of the study, 3,677 cases of remission were recorded. The overall rate of remission per 1,000 person-years stood at 10.5, which closely resembled the rate of 9.7 in the United Kingdom. Furthermore, individuals with HbA1c levels ranging from 48 to 53 mmol/mol (6.5% to 6.9%), those who did not take glucose-lowering medications initially, and those who experienced a ≥10% decrease in body mass index (BMI) within a year reported rates of 27.8, 21.7, and 48.2, respectively. Male gender, shorter disease duration, lower baseline HbA1c levels, higher baseline BMI, greater BMI reduction within one year, and absence of glucose-lowering medications at baseline were all significantly correlated with remission. Similar outcomes were observed when analyzing the maintenance of remission as an outcome over one year. Another aspect of the study focused on identifying factors that predicted relapse following a one-year remission period. Out of the 3,677 individuals who achieved remission, two-thirds (2,490) experienced relapse within one year. Longer diabetes duration, lower baseline BMI, and reduced BMI after one year were all significantly associated with relapse. Reflecting on the importance of their discoveries, Prof. Sone commented, "When compared to Westerners, Asians possess higher insulin sensitivity and a lower acute insulin response. Furthermore, Asians exhibit substantially lower obesity levels than their Western counterparts, and the pathogenesis of diabetes mellitus differs greatly between the two groups. Hence, the associations between baseline BMI, BMI reduction, remission, and relapse may hold greater significance in East Asian populations compared to Western populations, suggesting potential ethnic disparities in transitioning from overt hyperglycemia to nearly normal glucose levels."

Although the results of this analytical investigation offer valuable insights into remission among patients with type 2 diabetes, it is important to note that the study is purely observational and does not establish a cause-and-effect relationship. The authors themselves acknowledged this limitation and emphasized the need for future intervention studies involving lifestyle modifications and/or medications. Such studies would be necessary to ascertain the actual number of individuals who can achieve remission and determine the duration of remission in real-world settings. These prospective intervention studies would provide more robust evidence and further validate the findings of this observational study.