Type 2 Diabetes Remission Very Rare in Non-Bariatric Surgery Patients

American researchers looked at data on over 120,000 type 2 patients to find out what rates of remission were….

Previous studies have shown that bariatric surgery can result in long-term weight loss, improvement in cardiovascular risk factors, and a reduction in mortality rate of 15% from baseline. However, in a study in Veterans Affairs (VA), the study subjects did not show any survival benefits associated with bariatric surgery.

Researchers examined data on a total of 122,781 adults with type 2 diabetes who hadn’t had bariatric surgery. The average age of participants was 62 years old, 47.1% were female, and 51.6% male.

Remission was defined as follows:

• Partial: 1 year of pre-diabetic hyperglycemia (HbA1C level < 5.7- 6.4%)
• Complete: 1 year of normoglycemia (HbA1C level < 5.7%)
• Prolonged: complete remission for at least 5 years

In this cohort study, the results demonstrated that a partial, complete, and prolonged remission were 2.8 (95% CI 2.6-2.9), 0.24 (95% CI 0.20-0.28), and 0.04 (95% CI 0.01-0.06) cases per 1,000 person-years, respectively. After 7 years of follow up, the results of a partial, complete, and prolonged remission were 1.5 (95% CI 1.4-1.5%), 0.14% (95% CI 0.12-0.16%), and 0.01% (95% CI 0.003-0.02%), respectively. The 7 year cumulative occurrence of remission reduced with longer time from 4.6% (95% CI 4.3-4.9%) for participants who diagnosed with diabetes in the past 2 years to a low of 0.4% (95% CI 0.3- 0.5%)(P 10 years ago.

The authors concluded that remission of type 2 diabetes does exist without bariatric surgery, but it is uncommon. Seventy percent of patients who underwent bariatric surgery have demonstrated hospital remission within 5 years after surgery.

Practice Pearls:

• Data were collected from routine clinical practice rather than from a prescribed study protocol with regular collection interval. Therefore, the frequency of HbA1C collection may be varied and may not be accurate.
• The study has demonstrated, even though it was uncommon, remission of type 2 diabetes occurred in patients who have not undergone bariatric surgery.
• More studies are necessary to provide more evidence of these results while minimizing all the limitations.

Andrew J. Karter. Incidence of Remission in Adults With Type 2 Diabetes: The Diabetes & Aging Study. Diabetes Care 2014; 37:3188-3195