Type 2 Diabetes Remission—Analysis of Three Population-Level Historical Cohorts

Abstract

Objective: To analyze the characteristics of individuals who went into remission for type 2 diabetes mellitus (T2DM) in the absence of bariatric surgery in three large population level datasets. Methods: Data from three large T2DM cohorts were used in this analysis: a) 10,059 subjects from a longitudinal Medicare cohort (n=2.4 Million); b) 4,997 subjects, Continuous NHANES (n=82,091); and c) 562 subjects, NHANES III (n=33,994). A Medicare T2DM individual with no T2DM related claims continuously for more than 12 months was considered to be in remission. In the NHANES data T2DM remission was defined as an HbA1c ≤ 5.7 without T2DM related medications. Cox proportional hazards was used to identify significant variables associated with T2DM “remission” in the Medicare data. NHANES data were analyzed with multiple logistic regression with T2DM remission as the dependent variable. Results: In the Medicare dataset 4.97% met the criteria for T2DM remission in a five-year longitudinal study, while 2.76% and 1.97% of the continuous NHANES and the NHANES III subjects, respectively, achieved remission in the cross-sectional cohorts. The factors associated with T2DM remission were no statin use; no insulin use; no hypertension; no hyperlipidemia; no neuropathy; no retinopathy; female gender; non-African American ethnicity; decreased waist circumference and lower systolic blood pressure (Bonferroni adjusted p≤0.05). The rate of T2DM remission appears to be approximately 1.97 to 4.97%. Conclusions: T2DM remission triggers exist (Lancet, Dec 2017). Of the factors associated with T2DM remission, only ethnicity and gender are non-modifiable risk factors. Therefore, diabetes prevention and management programs should concentrate on lowering body weight, lipids, and blood pressure. Management of these factors is associated with T2DM remission. Identification of other factors associated with T2DM may lead to more efficacious programmatic management of the disease and attenuation of serious co-morbidities. Disclosure S. Tangelloju: Employee; Self; Humana Inc.. G. Vu: None. H. Chavis-Blakely: None. B.B. Little: None.