Type 2 diabetes remission more likely in patients taking fewer medications, study finds
Just 2.9% of more than 556,000 type 2 diabetes patients who did not undergo bariatric surgery achieved remission over three years, and 36.9% of them relapsed before the end of the three-year follow-up, according to analysis of data from six U.S. health systems.
Taking fewer diabetes medications and having a lower baseline HbA1c level and shorter diabetes duration were the characteristics most strongly associated with type 2 diabetes remission among a large and diverse cohort of U.S. adults, a retrospective study showed.
Researchers assessed data of 556,758 adults (mean age 59 years; 46.3% women) treated by six major U.S. health care delivery systems between January 2014 and June 2023. All had type 2 diabetes, one or more HbA1c measurements in the two years before study entry, and evidence of glucose-lowering medication use. Pregnant participants or those who underwent bariatric surgery before or during the study were excluded. Investigators defined remission as an HbA1c level lower than 6.5% persisting for at least three months after cessation of glucose-lowering medications. Findings were published by Diabetes Care on July 30.
A total of 16,016 patients (2.9%) achieved type 2 diabetes remission over three years of follow-up, although 36.9% of those who experienced remission relapsed. The characteristics most strongly associated with remission were not receiving glucose-lowering medications at baseline (odds ratio [OR] versus three or more medications, 15.9; 95% CI, 12.1 to 21.0), baseline HbA1c level less than 7% (OR versus 11% or greater, 3.1; 95% CI, 2.9 to 3.3) and diabetes duration of less than one year (OR versus four or more years, 2.6; 95% CI, 2.5 to 2.7).
Use of glucagon-like peptide-1 receptor agonists or sodium-glucose co-transporter-2 inhibitors was associated with decreased likelihood of remission (OR, 0.50; 95% CI, 0.34 to 0.73). Younger age and having more comorbidities were associated with remission. Compared with White patients, Black patients had higher odds of remission while Asian and Native Hawaiian or other Pacific Islander patients had lower odds. In total, 92.1% of remission episodes had at least one of the following factors: baseline HbA1c less than 7.0%, a diabetes duration of less than one year, or metformin monotherapy during follow-up.
Limitations include that researchers relied on medication supply as a proxy for use, potentially overestimating adherence, and that some patients may have been misclassified.
“These findings highlight actionable factors to identify patients who may benefit most from targeted interventions. Future research should evaluate the long-term durability and health impacts of remission,” the authors concluded.