Real-world data reveals remission rate of type 2 diabetes to be 1 in 100 patients

Japan: A recent study published in Diabetes, Obesity and Metabolism revealed a greater difference in remission (of type 2 diabetes) incidence and relapse predictors, particularly baseline BMI (body mass index), between East Asian and Western populations. 

Additionally, the study showed that the relationships between BMI reduction with relapse and remission might be greater in East Asian than in Western populations, indicating ethnic differences in returning from overt hyperglycaemia to nearly normal glucose levels

The phenomenon of improvement of glucose to levels in a normal range and cessation of the need for medication can occur in some patients diagnosed with type 2 diabetes who are provided with lifestyle therapy, temporary pharmacotherapy, bariatric surgery, or combinations of these treatments. However, this phenomenon is not yet fully understood in routine care settings, and many factors remain to be clarified. Moreover, since there are differences in insulin secretion and resistance between East Asian and Western populations, the natural history of diabetes seems to differ widely between Western populations and East Asians.

Therefore, these concerns led Dr. Kazuya Fujihara and colleagues to investigate the incidence/one-year relapse from remission and associated factors in patients with type 2 diabetes. In the study, the authors addressed these research questions using a database of specialists clinics. They analyzed the data of the Japan Diabetes Clinical Data Management Study Group (JDDM), one of the largest cohorts of Japanese people with type 2 diabetes. They tracked the information on 48,320 people with diabetes in Japan. In one arm of the study, they calculated remission rates per 1000 person-years. The authors reported that the median follow-up was 5.3 years.

During the study period, 3,677 remissions occurred. The overall incidence of remissions per 1,000 person-years was 10.5, similar to 9.7 in the United Kingdom. In addition, those with HbA1c levels of 48 to 53 mmol/mol (6.5% to 6.9%), those taking no glucose-lowering drugs at baseline, and those with a ≥10% body mass index (BMI) reduction in 1 year, it was 27.8, 21.7 and 48.2, respectively. Male sex, shorter duration, lower baseline HbA1c, higher baseline BMI, higher BMI reduction at one year, and no glucose-lowering drugs at baseline were significantly associated with remission. Similar results were obtained with the maintenance of remission over one year as an outcome. In another arm of the study, the investigators revealed the factors that predicted relapse from remission in 1 year. Among 3,677 individuals who entered remission, two-thirds (2,490) relapsed from remission within 1 year.

Longer duration of diabetes, lower BMI at baseline, and lower BMI reduction at one year were significantly associated with relapse. Commenting on the significance of their findings, Prof. Sone said, "Compared to Westerners, Asians have higher insulin sensitivity and lower acute insulin response. In addition, Asians have a much lower obesity level than Westerners, and the pathogenesis of diabetes mellitus is very different. Therefore, the relationships of baseline BMI and BMI reduction with remission and relapse may be greater in East Asian than in Western populations, implying ethnic differences in returning from overt hyperglycemia to nearly normal glucose levels".

While the findings of these analytical studies are impressive and provide new insight into remission in patients with type 2 diabetes should be, the authors noted that the "present study is an observational study and does not show a cause and effect relationship, and that future intervention studies with lifestyle and/or medication will be needed to confirm how many people actually achieve remission and how long the state of remission lasts in real-world setting".

Reference:

Kazuya Fujihara, Laymon Khin, Koshiro Murai, Yurie Yamazaki, Kahori Tsuruoka, Noriko Yagyuda, Katsuya Yamazaki, Hiroshi Maegawa , Shiro Tanaka, Satoru Kodama, Hirohito Sone, Published: 08 May 2023 https://doi.org/10.1111/dom.15100.