Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study.

<h4>Background</h4>Clinical pathways are changing to incorporate support and appropriate follow-up for people to achieve remission of type 2 diabetes, but there is limited understanding of the prevalence of remission in current practice or patient characteristics associated with remissio...

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Autores principales:	Mireille Captieux, Kelly Fleetwood, Brian Kennon, Naveed Sattar, Robert Lindsay, Bruce Guthrie, Sarah H Wild, Scottish Diabetes Research Network Epidemiology Group
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/6764c37192f04a959d08f71926f6d37c
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spelling	oai:doaj.org-article:6764c37192f04a959d08f71926f6d37c2021-12-02T19:55:35ZEpidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study.1549-12771549-167610.1371/journal.pmed.1003828https://doaj.org/article/6764c37192f04a959d08f71926f6d37c2021-11-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1003828https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Clinical pathways are changing to incorporate support and appropriate follow-up for people to achieve remission of type 2 diabetes, but there is limited understanding of the prevalence of remission in current practice or patient characteristics associated with remission.<h4>Methods and findings</h4>We carried out a cross-sectional study estimating the prevalence of remission of type 2 diabetes in all adults in Scotland aged ≥30 years diagnosed with type 2 diabetes and alive on December 31, 2019. Remission of type 2 diabetes was assessed between January 1, 2019 and December 31, 2019. We defined remission as all HbA1c values <48 mmol/mol in the absence of glucose-lowering therapy (GLT) for a continuous duration of ≥365 days before the date of the last recorded HbA1c in 2019. Multivariable logistic regression in complete and multiply imputed datasets was used to examine characteristics associated with remission. Our cohort consisted of 162,316 individuals, all of whom had at least 1 HbA1c ≥48 mmol/mol (6.5%) at or after diagnosis of diabetes and at least 1 HbA1c recorded in 2019 (78.5% of the eligible population). Over half (56%) of our cohort was aged 65 years or over in 2019, and 64% had had type 2 diabetes for at least 6 years. Our cohort was predominantly of white ethnicity (74%), and ethnicity data were missing for 19% of the cohort. Median body mass index (BMI) at diagnosis was 32.3 kg/m2. A total of 7,710 people (4.8% [95% confidence interval [CI] 4.7 to 4.9]) were in remission of type 2 diabetes. Factors associated with remission were older age (odds ratio [OR] 1.48 [95% CI 1.34 to 1.62] P < 0.001) for people aged ≥75 years compared to 45 to 54 year group), HbA1c <48 mmol/mol at diagnosis (OR 1.31 [95% CI 1.24 to 1.39] P < 0.001) compared to 48 to 52 mmol/mol), no previous history of GLT (OR 14.6 [95% CI 13.7 to 15.5] P < 0.001), weight loss from diagnosis to 2019 (OR 4.45 [95% CI 3.89 to 5.10] P < 0.001) for ≥15 kg of weight loss compared to 0 to 4.9 kg weight gain), and previous bariatric surgery (OR 11.9 [95% CI 9.41 to 15.1] P < 0.001). Limitations of the study include the use of a limited subset of possible definitions of remission of type 2 diabetes, missing data, and inability to identify self-funded bariatric surgery.<h4>Conclusions</h4>In this study, we found that 4.8% of people with type 2 diabetes who had at least 1 HbA1c ≥48 mmol/mol (6.5%) after diagnosis of diabetes and had at least 1 HbA1c recorded in 2019 had evidence of type 2 diabetes remission. Guidelines are required for management and follow-up of this group and may differ depending on whether weight loss and remission of diabetes were intentional or unintentional. Our findings can be used to evaluate the impact of future initiatives on the prevalence of type 2 diabetes remission.Mireille CaptieuxKelly FleetwoodBrian KennonNaveed SattarRobert LindsayBruce GuthrieSarah H WildScottish Diabetes Research Network Epidemiology GroupPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 11, p e1003828 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Mireille Captieux Kelly Fleetwood Brian Kennon Naveed Sattar Robert Lindsay Bruce Guthrie Sarah H Wild Scottish Diabetes Research Network Epidemiology Group Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study.
description	<h4>Background</h4>Clinical pathways are changing to incorporate support and appropriate follow-up for people to achieve remission of type 2 diabetes, but there is limited understanding of the prevalence of remission in current practice or patient characteristics associated with remission.<h4>Methods and findings</h4>We carried out a cross-sectional study estimating the prevalence of remission of type 2 diabetes in all adults in Scotland aged ≥30 years diagnosed with type 2 diabetes and alive on December 31, 2019. Remission of type 2 diabetes was assessed between January 1, 2019 and December 31, 2019. We defined remission as all HbA1c values <48 mmol/mol in the absence of glucose-lowering therapy (GLT) for a continuous duration of ≥365 days before the date of the last recorded HbA1c in 2019. Multivariable logistic regression in complete and multiply imputed datasets was used to examine characteristics associated with remission. Our cohort consisted of 162,316 individuals, all of whom had at least 1 HbA1c ≥48 mmol/mol (6.5%) at or after diagnosis of diabetes and at least 1 HbA1c recorded in 2019 (78.5% of the eligible population). Over half (56%) of our cohort was aged 65 years or over in 2019, and 64% had had type 2 diabetes for at least 6 years. Our cohort was predominantly of white ethnicity (74%), and ethnicity data were missing for 19% of the cohort. Median body mass index (BMI) at diagnosis was 32.3 kg/m2. A total of 7,710 people (4.8% [95% confidence interval [CI] 4.7 to 4.9]) were in remission of type 2 diabetes. Factors associated with remission were older age (odds ratio [OR] 1.48 [95% CI 1.34 to 1.62] P < 0.001) for people aged ≥75 years compared to 45 to 54 year group), HbA1c <48 mmol/mol at diagnosis (OR 1.31 [95% CI 1.24 to 1.39] P < 0.001) compared to 48 to 52 mmol/mol), no previous history of GLT (OR 14.6 [95% CI 13.7 to 15.5] P < 0.001), weight loss from diagnosis to 2019 (OR 4.45 [95% CI 3.89 to 5.10] P < 0.001) for ≥15 kg of weight loss compared to 0 to 4.9 kg weight gain), and previous bariatric surgery (OR 11.9 [95% CI 9.41 to 15.1] P < 0.001). Limitations of the study include the use of a limited subset of possible definitions of remission of type 2 diabetes, missing data, and inability to identify self-funded bariatric surgery.<h4>Conclusions</h4>In this study, we found that 4.8% of people with type 2 diabetes who had at least 1 HbA1c ≥48 mmol/mol (6.5%) after diagnosis of diabetes and had at least 1 HbA1c recorded in 2019 had evidence of type 2 diabetes remission. Guidelines are required for management and follow-up of this group and may differ depending on whether weight loss and remission of diabetes were intentional or unintentional. Our findings can be used to evaluate the impact of future initiatives on the prevalence of type 2 diabetes remission.
format	article
author	Mireille Captieux Kelly Fleetwood Brian Kennon Naveed Sattar Robert Lindsay Bruce Guthrie Sarah H Wild Scottish Diabetes Research Network Epidemiology Group
author_facet	Mireille Captieux Kelly Fleetwood Brian Kennon Naveed Sattar Robert Lindsay Bruce Guthrie Sarah H Wild Scottish Diabetes Research Network Epidemiology Group
author_sort	Mireille Captieux
title	Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study.
title_short	Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study.
title_full	Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study.
title_fullStr	Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study.
title_full_unstemmed	Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study.
title_sort	epidemiology of type 2 diabetes remission in scotland in 2019: a cross-sectional population-based study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/6764c37192f04a959d08f71926f6d37c
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_version_	1718375842501885952

Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study.

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