Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom.
PLoS Med. 2020 Oct 28;17(10):e1003396. doi: 10.1371/journal.pmed.1003396. eCollection 2020 Oct.
Remission has been identified as a top priority by people with type 2 diabetes. Remission is commonly used as an outcome in research studies; however, a widely accepted definition of remission of type 2 diabetes is lacking. A report on defining remission was published (but not formally endorsed) in Diabetes Care, an American Diabetes Association (ADA) journal. This Diabetes Care report remains widely used. It was the first to suggest 3 components necessary to define the presence of remission: (1) absence of glucose-lowering therapy (GLT); (2) normoglycaemia; and (3) for duration ≥1 year. Our aim is to systematically review how remission of type 2 diabetes has been defined by observational and interventional studies since publication of the 2009 report.
Four databases (MEDLINE, EMBASE, Cochrane Library, and CINAHL) were searched for studies published from 1 September 2009 to 18 July 2020 involving at least 100 participants with type 2 diabetes in their remission analysis, which examined an outcome of type 2 diabetes remission in adults ≥18 years and which had been published in English since 2009. Remission definitions were extracted and categorised by glucose-lowering therapy, glycaemic thresholds, and duration. A total of 8,966 titles/abstracts were screened, and 178 studies (165 observational and 13 interventional) from 33 countries were included. These contributed 266 definitions, of which 96 were unique. The 2009 report was referenced in 121 (45%) definitions. In total, 247 (93%) definitions required the absence of GLT, and 232 (87%) definitions specified numeric glycaemic thresholds. The most frequently used threshold was HbA1c<42 mmol/mol (6.0%) in 47 (20%) definitions. Time was frequently omitted. In this study, a total of 104 (39%) definitions defined time as a duration. The main limitations of this systematic review lie in the restriction to published studies written in English with sample sizes of over 100. Grey literature was not included in the search.
We found that there is substantial heterogeneity in the definition of type 2 diabetes remission in research studies published since 2009, at least partly reflecting ambiguity in the 2009 report. This complicates interpretation of previous research on remission of type 2 diabetes and the implications for people with type 2 diabetes. Any new consensus definition of remission should include unambiguous glycaemic thresholds and emphasise duration. Until an international consensus is reached, studies describing remission should clearly define all 3 components of remission.
PROSPERO CRD42019144619.
2 型糖尿病患者将缓解作为首要目标。缓解通常被用作研究结果的一个指标；然而，缺乏一个广泛接受的 2 型糖尿病缓解定义。《糖尿病护理》（美国糖尿病协会 (ADA) 杂志）发表了一篇关于定义缓解的报告（但未正式认可）。该《糖尿病护理》报告仍被广泛使用。它首次提出了定义缓解所需的 3 个组成部分：（1）无降糖治疗（GLT）；（2）血糖正常；（3）持续时间≥1 年。我们的目的是系统地回顾自 2009 年报告发表以来，观察性和干预性研究中 2 型糖尿病缓解的定义。
我们在四个数据库（MEDLINE、EMBASE、Cochrane 图书馆和 CINAHL）中搜索了至少有 100 名 2 型糖尿病患者参与缓解分析的研究，这些研究检查了≥18 岁成年人的 2 型糖尿病缓解结果，并于 2009 年以后以英文发表。我们提取了缓解定义，并根据降糖治疗、血糖阈值和持续时间进行分类。共筛选出 8966 篇标题/摘要，来自 33 个国家的 178 项研究（165 项观察性研究和 13 项干预性研究）被纳入。这些研究共提出了 266 个定义，其中 96 个是独特的。121 个（45%）定义引用了 2009 年的报告。总的来说，247 个（93%）定义需要没有 GLT，232 个（87%）定义指定了数值血糖阈值。最常用的阈值是 HbA1c<42mmol/mol（6.0%），占 47 个（20%）定义。时间经常被忽略。在这项研究中，共有 104 个（39%）定义将时间定义为持续时间。本系统评价的主要局限性在于仅限于发表在英文期刊上、样本量超过 100 人的研究，未包括灰色文献。
我们发现，自 2009 年以来发表的研究中，2 型糖尿病缓解的定义存在很大的异质性，这至少反映了 2009 年报告的模糊性。这使得以前关于 2 型糖尿病缓解的研究结果的解释变得复杂，并对 2 型糖尿病患者产生了影响。任何新的缓解共识定义都应包括明确的血糖阈值，并强调持续时间。在达成国际共识之前，描述缓解的研究应明确定义缓解的所有 3 个组成部分。
PROSPERO CRD42019144619。
