Incidence of remission in adults with type 2 diabetes: The Diabetes and Aging Study

Karter AJ, Nundy S, Parker MM, Moffet HH, Huang ES. Incidence of remission in adults with type 2 diabetes: The Diabetes and Aging Study. Diabetes Care. 2014; [ePub ahead of print]. doi: 10.2337/dc14-0874.

The Diabetes and Aging Study estimated the incidence of type 2 diabetes remission among an ethnically diverse population of 122,781 adults who were not treated with bariatric surgery. Type 2 diabetes remission required the absence of ongoing drug therapy and was defined as:

  • Partial: 2 or more consecutive A1C measurements of 5.7%-6.4% over at least 12 months
  • Complete: 2 or more consecutive A1C measurements <5.7% over at least 12 months
  • Prolonged: 2 or more consecutive A1C measurements <5.7% over at least 60 months 

Type 2 Diabetes Remission Is Rare 

The 7-year cumulative incidences of any, partial, complete, and prolonged remission were 1.60% (95% CI, 1.53-1.68), 1.47% (95% CI, 1.40-1.54), 0.14% (95% CI, 0.12-0.16), and 0.007% (95% CI, 0.003-0.02), respectively. Incidence rates/1,000 person-years:

  • All cases: 3.00 (95% CI, 2.86-3.14)
  • Cases <2 years since diagnosis: 8.77 (95% CI 8.15–9.39)
  • Cases 2-3 years since diagnosis: 4.74 (95% CI 4.29–5.19)
  • Cases 4-5 years since diagnosis: 3.03 (95% CI 2.63–3.42)
  • Cases 6-9 years since diagnosis: 1.49 (95% CI 1.25–1.72)
  • Cases ≥10 years since diagnosis: 0.67 (95% CI 0.53–0.80)

In bivariate and multivariable analyses, any remission was associated with less time since diagnosis (P<0.0001). The 7-year cumulative incidence of any remission was much lower for individuals using insulin (0.05%; 95% CI, 0.03-0.1%) or oral agents (0.3%; 95% CI, 0.2%-0.3%) at baseline compared with subjects not using medication at baseline (12%; 95% CI, 12%-13%).


Type 2 Diabetes Remission Is Associated With Older Age, Lower A1C, and Not Taking Diabetes  Medications 

Subjects who experienced remission were less likely than patients who did not experience remission to be first identified due to a diabetes-related medication (29% vs. 93%, respectively), abnormal laboratory test results (68% vs. 93%, respectively), or hospital discharge (4% vs. 9%, respectively). This suggests that patients who eventually experienced remission had less advanced diabetes at the onset and more often received diagnoses from their provider without laboratory evidence.

 
In the new-onset cohort (defined as <2 years since diagnosis), any remission was associated with lower baseline A1C and not taking diabetes medication. Older age, higher socioeconomic status, and moderate renal impairment were associated with remission in the unadjusted model (P<0.0001), but were attenuated in the fully adjusted model (P<0.05). African-American race and no dyslipidemia were associated with remission in the fully adjusted model.
  

Clinical Significance for HCPs 

  • About 2% of individuals with recent evidence of clinical type 2 diabetes who were not treated with bariatric surgery achieved at least partial remission over 7 years. 
  • Remission was associated with less time since diagnosis, lower A1C levels at baseline, older age, and not taking diabetes medications
  • Type 2 diabetes remission is rare, but these findings challenge the widespread assumption that type 2 diabetes is irreversible and progressive.
 
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Related content: 

For more on Type 2 Diabetes Remission, click here 

  

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States. 

October 2014 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

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Last Modified: 11/14/2014