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

Holman, N. , Wild, S. H., Khunti, K., Knighton, P., O'Keefe, J., Bakhai, C., Young, B., Sattar, N. , Valabhji, J. and Gregg, E. W. (2022) Incidence and characteristics of remission of type 2 diabetes in England: a cohort study using the National Diabetes Audit. Diabetes Care, 45(5), pp. 1151-1161. (doi: 10.2337/dc21-2136) (PMID:35320360) (PMCID:PMC9174970)

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Abstract

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 1 April 2018 were identified from a national collation of health records in England and followed until 31 December 2019. Remission was defined as two HbA1c measurements of <48 mmol/mol (6.5%) at least 182 days apart, with no prescription for glucose-lowering medications 90 days before these measurements. Results: In 2,297,700 people with type 2 diabetes, the overall incidence of remission per 1,000 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 <1 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 socioeconomic deprivation. Among 8,940 (0.4%) with characteristics associated with remission (diagnosed <2 years, HbA1c <53 mmol/mol [7.0%], prescribed metformin alone or no glucose-lowering medications, BMI reduction of ≥10%), incidence of remission per 1,000 person-years was 83.2 (95% CI 78.7–87.9). 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 lose a significant amount of weight shortly after diagnosis. Policies that encourage intentional remission of type 2 diabetes should seek to reduce the ethnic and socioeconomic inequalities identified.

Item Type:Articles
Additional Information:N.H is funded by Diabetes UK and NHS England, and NHS Improvement (grant number 20/0006367). K.K. is supported by the National Institute for Health Research Applied Research Collaboration East Midlands and the National Institute for Health Research Leicester Biomedical Research Centre. N.S. is supported by the British Heart Foundation Research Excellence Award (RE/18/6/34217).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Sattar, Professor Naveed and Holman, Ms Naomi
Authors: Holman, N., Wild, S. H., Khunti, K., Knighton, P., O'Keefe, J., Bakhai, C., Young, B., Sattar, N., Valabhji, J., and Gregg, E. W.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Diabetes Care
Publisher:American Diabetes Association
ISSN:0149-5992
ISSN (Online):1935-5548
Published Online:23 March 2022
Copyright Holders:Copyright © 2022 by the American Diabetes Association
First Published:First published in Diabetes Care 2022
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science