Oct 2016 DOI: 10.1093/ije/dyw152, McKeigue PM, Spiliopoulou A, McGurnaghan S, Colombo M, McDonald TJ, Colhoun HM, on behalf of the SDRNT1BIO investigators. S3 Table. Patterns of Glucose and Diabetes Management among Scottish Diabetes Research Network Type 1 Diabetes Bioresource participants. After 2 years of follow-up, they reported remission of 36% in their intervention group and 3% in their control group [12]. glucose-lowering therapy;ICD-10, Finally, we may have underestimated the proportion of people who had received bariatric surgery as we did not have access to data on procedures performed in private hospitals, but bariatric surgery is relatively uncommon in the UK. Similarities between our findings and Karter and colleagues were that remission of type 2 diabetes was more common in people aged 65 years, people who were not prescribed GLT at diagnosis of diabetes, and people who had a lower HbA1c at diagnosis. Poster presentation at the 53, Colombo M, Valo E, McGurnaghan S, Blackbourn L, Dalton RN, Dunger D, Groop PH, McKeigue PM, Forsblom C, Colhoun HM, on behalf of the SDRNT1BIO and Finndiane Investigators. There is a sizeable proportion of people who achieve remission of type 2 diabetes outside research trials and without bariatric surgery. For age and continuous covariates, the same categories as baseline were applied. Background: The Scottish Diabetes Research Network (SDRN) was commissioned in 2006 by the Chief Scientist Office ( CSO) of the Scottish Government to improve the quality and increase the quantity of diabetes research in Scotland, as part of the UK Clinical Research Collaboration ( UKCRC ). It is important to recognise that remission of diabetes may not be permanent. PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US. The University of Edinburgh, Western General Hospital Crewe Road South Edinburgh EH4 2XU . STROBE, STROBE, Strengthening The Reporting of OBservational Studies in Epidemiology. Diabetes Remission Clinical Trial;DPP-4, OPCS-4 procedure codes used in combination with ICD-10 diagnosis codes for obesity and type 2 diabetes by Public Health Scotland to identify people with a history of bariatric surgery. Methods Repeated annual cross-sectional studies of type 1 diabetes incidence were conducted. Prevalence of remission of type 2 diabetes among the Scottish type 2 diabetes population of people who had at least 1 HbA1c 48 mmol/mol (6.5%) after diagnosis of diabetes and had at least 1 HbA1c recorded in 2019. -. These people should be recognised and coded appropriately so they can be supported by their clinicians. Older people develop diabetes at lower BMI and lower HbA1c than their younger counterparts [27]. S2 Fig. Methods and findings: Findings from trial settings have shown that remission is more likely in people with a short duration of diabetes. Clipboard, Search History, and several other advanced features are temporarily unavailable. I have read the journals policy and the authors of this manuscript have the following competing interests: BK is national lead for diabetes and chair of the Scottish Diabetes Group which sits directly within the Clinical Priorities team at Scottish Government, member of the Type 2 Diabetes Prevention Oversight group which is a Scottish Government related group, speciality adviser to Chief Medical Officer for diabetes and endocrine. International Diabetes Federation. doi:10.1371/journal.pmed.1003828, Academic Editor: Ronald C. W. Ma, Chinese University of Hong Kong, CHINA, Received: June 8, 2021; Accepted: September 30, 2021; Published: November 2, 2021. Diabetes research (Edinburgh, Scotland) Publications The influence of insulin and sorbinil on myo-inositol uptake in peripheral nerve from normal and diabetic rats and a neuroblastoma cell line. By 2045, it is estimated that there will be 700 million people in the world with diabetes. We found that the prevalence of type 2 diabetes remission in the study population was 4.8% in our primary analysis. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Trends in type 2 diabetes incidence and mortality in Scotland between This unified centre facilitates service development, quality improvement, training and education in endocrinology and diabetes in Edinburgh and the Lothians. Trends in incidence and mortality rates are described for type 2 diabetes in Scotland between 2004 and 2013 by age, sex and socioeconomic deprivation. CI, confidence interval; GLT, glucose-lowering therapy; OR, odds ratio. We calculated how many people were in remission of type 2 diabetes in 2019 in Scotland from a national type 2 diabetes register. RL has served on advisory boards with Novo Nordisk, Lily and Servier only NS has consulted for Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, and Sanofi, and received grant support from Boehringer Ingelheim, Novartis and Roche, outside the submitted work. However, the Diabetes UK (DUK)James Lind Alliance Priority Setting Partnership has recently identified remission of type 2 diabetes as the top shared priority among people living with diabetes and their carers and healthcare professionals [13], and the findings of the work are being shared with patient groups, Diabetes Scotland, and DUK. Multivariable logistic regression in complete and multiply imputed datasets was used to examine characteristics associated with remission. Patients and the public were not involved in the design, conduct, or reporting of this research. We are delighted to have been awarded these research funds from Diabetes UK. Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross Further cohort studies could build on our results to develop and validate risk scores for remission of diabetes. Citation: Captieux M, Fleetwood K, Kennon B, Sattar N, Lindsay R, Guthrie B, et al. Prescription data were defined using Read Codes, the clinical terminology system widely used in UK general practice. ORs for remission of type 2 diabetes (95% CI) in Scotland 2019 derived, Fig 4. Rates were almost threefold in the most versus least socioeconomically deprived quintiles of the population. For secondary analyses, adjusted mean ambulatory systolic blood pressure was 3.06 mmHg lower (95% CI 0.565.56 mmHg,p= 0.017) and mean ambulatory diastolic blood pressure was 2.17 mmHg lower (95% CI 0.623.72,p= 0.006) among people in the intervention group when compared with usual care after adjustment for baseline differences and minimization strata. This was an exploratory cross-sectional analysis for which there was no . S5 Table. -, Nagi D, Hambling C, Taylor R. Remission of type 2 diabetes: a position statement from the Association of British Clinical Diabetologists (ABCD) and the Primary Care Diabetes Society (PCDS). Such a definition would be difficult to implement in routine healthcare records. Riddle and colleagues define remission as HbA1c <6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy (p. 1) [7] (at least 6 months after starting a lifestyle intervention) [7]. Queen dons lab coat to learn about diabetes research PURPOSE: The Scottish Diabetes Research Network (SDRN)-diabetes research platform was established to combine disparate electronic health record data into research-ready linked datasets for diabetes research in Scotland. S4 Table. doi: 10.1002/14651858.CD009966.pub2. The Scottish Diabetes Research Network (SDRN) is a clinical research network which coordinates and facilitates diabetes research across Scotland. government site. Scottish Diabetes Research Network Type 1 Bioresource (SDRNT1BIO). We used a cross-sectional whole population study design to estimate the prevalence of remission of type 2 diabetes in Scotland in 2019 and describe the characteristics of people in remission and people not in remission. Find out more about the Diabetes Scotland team. There may be a tendency to remission (as currently defined) with age, given the association between age and increasing number and severity of comorbidities that may predispose to unintentional weight loss. Taylor R, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Sattar N, Welsh P, Peters C, Zhyzhneuskaya S, Hollingsworth KG, Al-Mrabeh A, Rodrigues AM, Rehackova L, Adamson AJ, Sniehotta FF, Mathers JC, Ross HM, McIlvenna Y, Kean S, Ford I, McConnachie A, Lean MEJ. We reported our findings using the Strengthening The Reporting of OBservational Studies in Epidemiology (STROBE) Checklist for cross-sectional studies (S1 Table). Approval for creation of the linked dataset used in this analysis was obtained from the Scotland A multicentre research ethics committee, reference number 11/AL/0225. on behalf of the Scottish Diabetes Research Network Epidemiology Group, https://www.informationgovernance.scot.nhs.uk/pbpphsc/, https://www.cso.scot.nhs.uk/personal-awards-initiative/clinical-academic-fellowships/, https://www.diabetesatlas.org/upload/resources/material/20200302_133351_IDFATLAS9e-final-web.pdf, https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf, https://www.gov.scot/binaries/content/documents/govscot/publications/publication/2018/07/healthier-future-framework-prevention-early-detection-early-intervention-type-2/documents/healthier-future-framework-prevention-early-detection-early-intervention-type-2-diabetes/healthier-future-framework-prevention-early-detection-early-intervention-type-2-diabetes/govscot%3Adocument/healthier-future-framework-prevention-early-detection-early-intervention-type-2-diabetes.pdf, https://www.gov.scot/publications/scottish-index-multiple-deprivation-2016/, https://argoshare.is.ed.ac.uk/healthyr_book/, https://www.who.int/diabetes/publications/report-hba1c_2011.pdf?ua=1, Corrections, Expressions of Concern, and Retractions. We carried out a cross-sectional study estimating the prevalence of remission of type 2 dia- betes in all adults in Scotland aged 30 years diagnosed with type 2 diabetes and alive on December 31, 2019. For the purposes of this analysis, we defined remission on the basis of all HbA1c values being <48 mmol/mol in the absence of GLT for a duration of 365 days before the date of the last recorded HbA1c in 2019, that is on the basis of at least 2 HbA1c values <48 mmol/mol at an interval of at least 365 days. We defined GLT as any combination of metformin, sulphonylureas, thiazolidinediones, dipeptidyl peptidase 4 (DPP-4) inhibitors, sodium glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor (GLP-1) agonists, and insulin. Participants were between 20 and 65 years of age, with body mass index (BMI) 27 to 45 kg/m2, and within 6 years since diabetes diagnosis. We have also carried out N-glycome analysis on blood samples, which looks at the association between changes in the structure of important signalling complex molecules and the development of diabetic kidney disease. A 70% increase in prevalent cases of T1DM in those aged under 15 years in Europe between 2005 and 2020 is predicted. doi: 10.1007/s00125-016-4054-9 ; PubMed Central PMCID: PMC5016553. 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. Duration of type 2 diabetes on December 31, 2019 was calculated using date of diagnosis and categorised into 2 groups: 6 years and >6 years. The University of Edinburgh is a charitable body, registered in Scotland, with registration number Bariatric surgery was associated with remission independently of weight loss, and this is consistent with previously documented findings that bariatric surgery, particularly malabsorptive bariatric procedures, is associated with remission of type 2 diabetes prior to significant weight loss [28]. Jans A, Nslund I, Ottosson J, Szabo E, Nslund E, Stenberg E. PLoS Med. International Diabetes Federation;MAR, N = 117,048. The association between the reduction of body weight and new-onset type 2 diabetes remission in middle-aged Japanese men: Population-based Panasonic cohort study 8. Clinicians also need greater clarity on how to manage older or frailer people who achieve remission criteria. Prevalence of remission of type 2 diabetes among people with type 2 diabetes, Fig 3. Edinburgh actively contributes to the study programme of the Scottish Diabetes Research Network (SDRN). The recent finding that type 2 diabetes is independently associated with increased odds of death with Coronavirus Disease 2019 (COVID-19) may further accelerate interest in achieving remission of type 2 diabetes [17]. People with previous history of dementia, end-stage renal disease, liver cirrhosis, cancer, or metastases in the last 5 years removed. Although remission of type 2 diabetes has been observed in trial settings and following bariatric surgery, it is unclear how common remission is in normal care. 9th. The prevention of progression of arterial disease and diabetes (POPADAD Bethesda, MD 20894, Web Policies Two recent trials have additionally shown that it is also possible to achieve remission of type 2 diabetes through weight loss using very low calorie diets [10,11]. Position statements or recommendations for practice have been published by the Primary Care Diabetes Society (PCDS) [4], the International Diabetes Federation (IDF) [5], and a multidisciplinary group of experts [6] in 2019, 2017, and 2009, respectively. 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. An official website of the United States government. Odds ratios (ORs) over 1 indicate higher odds of missingness relative to the reference category (see S4 Table for details) [23]. A total of 7,710 people (4.8% [95% confidence interval [CI] 4.7 to 4.9]) were in remission of type 2 diabetes. Lo C, Jun M, Badve SV, Pilmore H, White SL, Hawley C, Cass A, Perkovic V, Zoungas S. Cochrane Database Syst Rev. Characteristics associated with type 2 diabetes remission in 2019 in the primary logistic regression analysis of the imputed dataset were age in 2019, HbA1c at diagnosis, weight change, history of GLT, and history of bariatric surgery. PLOS Medicine publishes research and commentary of general interest with clear implications for patient care, public policy or clinical research agendas. Further information is available in the patient information and support section. Diabet Med. Journal papers reporting on the findings of these studies will be finalised over the coming months. United Kingdom governments have recently included remission of type 2 diabetes in their long-term type 2 diabetes frameworks [14,15], and the American Diabetes Association (ADA) Standards of Medical Care has, for the first time, included guidance on prescribing very low calorie diets to improve glycaemic control and promote remission of diabetes [16]. . The DiaRem score (developed to predict probability of remission within 5 years after bariatric surgery) also showed that age, HbA1c level, and GLT use were preoperative predictors of remission [31]. Relationship between urinary neopterin excretion and islet cell antibodies in type 1 (insulin-dependent) diabetes.. 17. 2022 Sep;14(9):606-619. doi: 10.1111/1753-0407.13314. Estimating the prevalence of remission of type 2 diabetes in Scotland in 2019 creates a baseline to evaluate the impact of future initiatives to support remission and for future studies of duration of remission and effect on risk of complications of diabetes. copyright The University of Edinburgh. Scottish Care Information-Diabetes;SGLT-2, In our systematic review, we discussed the inconsistency of current diabetes diagnostic criteria with existing remission criteria [8]. It does not include name or address and dates of birth only include month and year apart from for babies. The Diabetes Remission Clinical Trial (DiRECT) was the first trial to use a low calorie diet intervention to assess type 2 diabetes remission as a primary outcome. Office of Population Censuses and Surveys Classification of Interventions and Procedures version 4;OR, Following complete cessation of all GLT. [4] (p. 74). This unified centre facilitates service development, quality improvement, training and education in endocrinology and diabetes in Edinburgh and the Lothians. When we excluded people with severe comorbidity (5.8% in the multiple imputed dataset) in a sensitivity analysis, we found that all the previously described associations between our covariates and remission in 2019 persisted with only small changes in ORs and CIs (Fig 4, S6 Table, S4 and S5 Figs). Thank you for contributing to our leading diabetes research. Guidelines for supporting people who achieve remission of diabetes must recognise differences between people that lose weight intentionally and those that lose weight because of severe illness. Sensitivity analysis with 10,846 people with comorbidities removed. People who have not yet been prescribed drugs to treat diabetes may be the most appropriate group for clinicians to initiate discussions around remission and weight management options. Prevalence of remission was estimated to be 3.7% if none of the 17% of people with missing HbA1c data for 2019 was in remission. 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. available, use up and down arrows to review and Enter to select. International Journal of Epidemiology. McGurnaghan SJ, Blackbourn LAK, Caparrotta TM, Mellor J, Barnett A, Collier A, Sattar N, McKnight J, Petrie J, Philip S, Lindsay R, Hughes K, McAllister D, Leese GP, Pearson ER, Wild S, McKeigue PM, Colhoun HM. Fig 1. We have previously shown that there were at least 96 unique definitions of diabetes remission used in the research literature from 2009 to 2020 [8]. Cohort Profile: Scottish Diabetes Research Network Type 1 Bioresource Study (SDRNT1BIO). The lack of history of GLT prescription had a particularly strong association with remission.
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