Abstract
Type 2 diabetes mellitus (T2DM) is a chronic progressive disorder and is associated with significant morbidity and mortality. The concept of T2DM remission and the reversal of diabetic parameters to normal levels has been gaining momentum over the past years. T2DM remission is increasingly being recognized by various global guidelines. Multiple models have been developed and validated for quantifying the extent of remission achieved. Based on favorable clinical evidence, T2DM remission can be considered as the therapeutic goal in diabetes management and, in select cases, as an alternative to expensive treatment options, which can be burdensome as T2DM progresses. This narrative review discusses the available strategies, such as lifestyle interventions, physical activity, bariatric surgery, medical nutrition therapy, and non-insulin glucose-lowering medications, for achieving T2DM remission. Although the concept of T2DM remission has emerged as a real-world option, effective implementation in routine clinical practice may not be feasible until long-term studies prove the efficacy of different approaches in this regard.
Highlights
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A simpler definition was proposed by Nagi et al in 2019 as the achievement of glycemia lower than the threshold value currently used for the diagnosis of Type 2 diabetes mellitus (T2DM), which is sustained for a minimum duration of six months after discontinuation of all glucose-lowering therapies [10]
A more contemporary definition has been proposed by Kalra et al, wherein T2DM remission has been defined as a healthy clinical state associated with the achievement of HbA1c below the targeted threshold, which is maintained for a minimum period of six months, with or without the continuous use of metformin and/or lifestyle changes, provided the condition is not due to comorbidities, concomitant therapies, or complications [12]
Summary
Diabetes is increasingly being recognized as a major global health epidemic [1]. The global prevalence of diabetes is expected to rise from 9.3% in 2019 to 10.9% in 2045. In 2019, there were an estimated 4.2 million deaths worldwide due to diabetes [2]. The complications associated with diabetes are accountable for significant morbidity and mortality. Diabetes imposes a significant economic burden, with an estimated health expenditure of USD 760.3 billion in 2019 [2]. People with diabetes are at a high risk for several cardiometabolic ailments and all-cause mortality [3]. A healthy lifestyle and the maintenance of a healthy body weight can prevent or delay diabetes [3]
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