Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K.
Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, U.K.
Diabetes Care. 2022 May 1;45(5):1151-1161. doi: 10.2337/dc21-2136.
To assess the incidence of remission of type 2 diabetes in routine care settings.
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.
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).
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.
评估 2 型糖尿病在常规护理环境下缓解的发生率。
从英国全国健康记录的汇总中确定了 2018 年 4 月 1 日存活的 2 型糖尿病患者(HbA1c≥48mmol/mol [6.5%]或<48mmol/mol [6.5%],有降血糖药物处方),并随访至 2019 年 12 月 31 日。缓解定义为两次 HbA1c 测量值至少相隔 182 天,<48mmol/mol(6.5%),在这些测量值之前的 90 天内没有开降血糖药物处方。
在 2297700 例 2 型糖尿病患者中,每 1000 人年的缓解发生率为 9.7(95%CI9.6-9.8),75610 例(3.3%)患者诊断时间<1 年的缓解发生率为 44.9(95%CI44.0-45.7)。除了诊断时间较短外,与缓解几率较高相关的基线因素包括未开具降血糖药物处方、较低的 HbA1c 和 BMI、BMI 降低、白种人、女性、较低的社会经济剥夺。在 8940 例(0.4%)有缓解特征的患者(<2 年诊断、HbA1c<53mmol/mol [7.0%]、单独开二甲双胍或不开降血糖药物、BMI 降低≥10%)中,每 1000 人年的缓解发生率为 83.2(95%CI78.7-87.9)。
2 型糖尿病在常规护理环境下缓解的情况通常很少见,但对于在诊断后不久体重显著减轻的一部分人来说,可能是一个合理的目标。鼓励有针对性地缓解 2 型糖尿病的政策应寻求减少所确定的种族和社会经济不平等。