Sheils Natalie E, Jarvis Megan S, Bangerter Lauren R, Asch David A, Clark Callahan N
Optum Labs, Minnetonka, MN.
University of Pennsylvania, Philadelphia, PA.
Diabetes Spectr. 2023 Summer;36(3):211-218. doi: 10.2337/ds22-0042. Epub 2022 Dec 5.
A 2021 international consensus statement defined type 2 diabetes remission as A1C <6.5% measured at least 3 months after cessation of glucose-lowering therapy. We aimed to investigate whether retrospective claims-based data can assess remission based on this definition, whether three increasingly strict alternative definitions affect the prevalence of remission and characteristics of remission cohorts, and how cohorts with and without sufficient data to assess for remission differ.
We used de-identified administrative claims from commercially insured and Medicare Advantage members, enriched with laboratory values, to assess diabetes remission. We used alternative glycemic, temporal, and pharmacologic criteria to assess the sensitivity of remission definitions to changes in claims-based logic.
Among 524,076 adults with type 2 diabetes, 185,285 (35.4%) had insufficient additional laboratory and/or enrollment data to assess for remission. While more likely to be younger, these individuals had similar initial A1C values and geographical distribution as the 338,791 (64.6%) assessed for remission. Of those assessed for remission, 10,694 (3.2%) met the 2021 consensus statement definition. The proportion of individuals meeting the three alternative definitions ranged from 0.8 to 2.3%. Across all criteria, those meeting the remission definition were more likely to be female, had a lower initially observed A1C, and had a higher prevalence of bariatric surgery.
This study demonstrates the feasibility of laboratory-value enriched claims-based assessments of type 2 diabetes remission. Establishing stable claims-based markers of remission can enable population assessments of diabetes remission and evaluate the association between remission and clinical outcomes.
2021年的一份国际共识声明将2型糖尿病缓解定义为在停止降糖治疗至少3个月后测得的糖化血红蛋白（A1C）<6.5%。我们旨在研究基于回顾性索赔的数据能否根据这一定义评估缓解情况，三种日益严格的替代定义是否会影响缓解的患病率及缓解队列的特征，以及有足够数据和无足够数据评估缓解情况的队列之间有何差异。
我们使用了来自商业保险和医疗保险优势计划参保者的匿名行政索赔数据，并补充了实验室检查值，以评估糖尿病缓解情况。我们采用替代的血糖、时间和药理学标准，来评估缓解定义对基于索赔逻辑变化的敏感性。
在524,076例2型糖尿病成人患者中，有185,285例（35.4%）没有足够的额外实验室检查和/或登记数据来评估缓解情况。虽然这些人更年轻，但他们的初始A1C值和地理分布与接受缓解评估的338,791例（64.6%）患者相似。在接受缓解评估的患者中，有10,694例（3.2%）符合2021年共识声明的定义。符合三种替代定义的个体比例在0.8%至2.3%之间。在所有标准中，符合缓解定义的人更可能为女性，初始观察到的A1C较低，且接受减重手术的患病率较高。
本研究证明了基于补充实验室检查值的索赔评估2型糖尿病缓解情况的可行性。建立稳定的基于索赔的缓解标志物可以对糖尿病缓解情况进行人群评估，并评估缓解与临床结局之间的关联。
