Our cohort consisted of 162,316 individuals, all of whom had at least 1 HbA1c 48 mmol/mol (6.5%) at or after diagnosis of diabetes and at least 1 HbA1c recorded in 2019 (78.5% of the eligible population). A company limited by guarantee registered in England and Wales with (no.00339181) and registered office at Wells Lawrence House, 126 Back Church Lane London E1 1FH. This site needs JavaScript to work properly. 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. It is important to recognise that remission of diabetes may not be permanent. Contact us by [email protected]. Genotypic Associations with C-peptide Persistence in People with Type 1 Diabetes. SC005336, VAT Registration Number GB592950700, and is acknowledged by the UK authorities as a 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. Our prevalence estimates suggest that a reasonably large proportion of people achieve remission of type 2 diabetes in routine clinical care outside trial or bariatric surgery settings. Scottish Diabetes Research Network Data were analysed using R version 3.4.4. HHS Vulnerability Disclosure, Help The University of Edinburgh is independently rated as one of the top 20 universities in the world. Thank you for contributing to our leading diabetes research. The current research projects in 2017-18 are: Glycaemia Trajectories in Type 1 Diabetes and their Association with Complications (Diabetes UK funded) Harnessing genetic information in the SDRNT1BIO to understand Type 1 diabetes and its complications (Diabetes UK funded) Extreme Phenotypes Relevant to Diabetic Complications in Type 1 Diabetes . This could reduce the burden of chronic disease for both patients and health services. Covariates were chosen based on previous literature [11,20] and clinical relevance. The second sensitivity analysis assumed all people who had never had an HbA1c 48 mmol/mol were in remission. CI, confidence interval; GLT, glucose-lowering therapy; OR, odds ratio. A key strength of this study was that it was unlikely to have been unduly influenced by selection bias due to the use of a large contemporary whole population data registry. The Diabetes Informatics and Epidemiology team at the University of Edinburgh hosts a Patients Advisory Committee (PAC) that scrutinises and makes recommendations on the use of the data, priorities for research as well as advising on messaging key findings to the diabetes community. and transmitted securely. A number of clinical diabetes and endocrinology studies are being conducted by the centre's NHS consultants, including contributions to multi-centre trials and audits. 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. Please enable it to take advantage of the complete set of features! PMC e1003828. SC005336, VAT Registration Number GB592950700, and is acknowledged by the UK authorities as a ICD-10, International Classification of Diseases-10th revision; OPCS-4, Office of Population Censuses and Surveys Classification of Interventions and Procedures version 4. Another strength is that type of diabetes assigned by clinicians and the date of diagnosis held on SCI-Diabetes are validated for research purposes by an algorithm that uses prescription patterns, first mention of HbA1c 48 mmol/l (6.5%), retinopathy screening, and GLT prescription [2]. S3 Table. Type of diabetes in SCI-Diabetes is validated for research purposes using an algorithm combining clinical coding, treatment, and age of onset [2,19]. Scottish Diabetes Research Network. 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. Recognised body which has been From this population, we selected people who were aged 30 years who were diagnosed with type 2 diabetes between January 1, 2004 (when registration to SCI-Diabetes was near complete across Scotland) and December 31, 2018 [2]. 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. Trends in incidence and mortality rates are described for type 2 diabetes in Scotland between 2004 and 2013 by age, sex and socioeconomic deprivation. ECED is a unified service operating across the Royal Infirmary of Edinburgh (RIE), Western General Hospital (WGH) and St John's Hospital (SJH), as well as being affiliated with colleagues in paediatrics (Royal Hospital for Children & Young People), endocrine and transplant surgery (Royal Infirmary of Edinburgh), neurosurgery (Royal Infirmary of Edinburgh), reproductive endocrinology (Royal Infirmary of Edinburgh), oncology (Western General Hospital) and ophthalmology (Princess Alexandra Eye Pavilion). 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. We are delighted to have been awarded these research funds from Diabetes UK. 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. The first sensitivity analysis assumed that none of the people without an HbA1c reading in 2019 were in remission. -, 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). Additionally, evaluating the impact of new clinical pathways to support remission of type 2 diabetes requires understanding of patterns of remission prior to introduction of new services. Edinburgh actively contributes to the study programme of the Scottish Diabetes Research Network (SDRN). International Diabetes Federation. This may influence associations between attainment of remission and mortality. 1 Adjusted for all variables in the model (listed in first column of the table). Recognised body which has been Taking Part in Research Studies Edinburgh Centre for Endocrinology Such a definition would be difficult to implement in routine healthcare records. Relation of incident Type 1 diabetes to recent COVID-19 - medRxiv 1988 2023 Jan 16;13:1019390. doi: 10.3389/fendo.2022.1019390. Factors associated with remission were older age (odds ratio [OR] 1.48 [95% CI 1.34 to 1.62] P < 0.001) for people aged 75 years compared to 45 to 54 year group), HbA1c <48 mmol/mol at diagnosis (OR 1.31 [95% CI 1.24 to 1.39] P < 0.001) compared to 48 to 52 mmol/mol), no previous history of GLT (OR 14.6 [95% CI 13.7 to 15.5] P < 0.001), weight loss from diagnosis to 2019 (OR 4.45 [95% CI 3.89 to 5.10] P < 0.001) for 15 kg of weight loss compared to 0 to 4.9 kg weight gain), and previous bariatric surgery (OR 11.9 [95% CI 9.41 to 15.1] P < 0.001). Previous history of bariatric surgery also had a strong association with diabetes remission; however, bariatric surgery was rare in the study cohort (488 people), while there were almost 31,000 people with no history of GLT prescription. Sarah Kiff, . Moreover, HbA1c alone is not always appropriate to diagnose diabetes, and, similarly, may not always be appropriate to diagnose remission, for example, for people with certain haemoglobinopathies or anaemia of chronic disease [8,29]. The prevention of progression of arterial disease and diabetes (POPADAD People with a previous history of bariatric surgery had higher odds of remission compared with people with no previous history (OR 11.93 (95% 9.41 to 15.13) P < 0.001) (Fig 3). This research could provide new avenues of T1DM prevention or management, contributing to the evidence base for balancing the benefits and the potential adverse effects of tightly regulating blood glucose levels. Brian Kennon, . Continuous covariates at diagnosis were defined as the median of all values recorded within a 90-day window around diagnosis (HbA1c at diagnosis; BMI at diagnosis; and weight at diagnosis). granted degree awarding powers. The proportion of people in remission of type 2 diabetes in the subset of our population who were eligible for participation in the DiRECT trial was 4.7% (95% CI 4.4 to 5.0). S5 Table. Associations between demographic and clinical covariates and type 2 diabetes remission were examined using univariable and multivariable logistic regression analysis on both complete case and multiple imputation datasets. Other potential options include use of estimated HbA1c; however, this is not established in routine clinical settings [7,30]. A full account of the clinics (including subspecialty clinics) offered by ECED is available by selecting the individual diabetes clinics or endocrine clinics tabs, above. Diabetes Care. SCI-Diabetes contains demographic and clinical data for over 99.5% of people with a diagnosis of diabetes in Scotland [18]. 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 British Diabetic Association operating as Diabetes UK,acharity registered in England and Wales (no. Sensitivity analysis with 10,846 people with comorbidities removed. Informed decisions need to be made about which people are most likely to achieve and maintain remission; to do this, we need to better understand the characteristics of people who are currently in remission. The woman who blazed a trail in mountain rescue - BBC News SC039136). S1 Fig. Guidelines are required for management and follow-up of this group and may differ depending on whether weight loss and remission of diabetes were intentional or unintentional. The NHS Research Scotland . Diabetes Medical Informatics and Epidemiology Research Group, MRC Institute of Genetics and Molecular Medicine. Lo C, Jun M, Badve SV, Pilmore H, White SL, Hawley C, Cass A, Perkovic V, Zoungas S. Cochrane Database Syst Rev. Freedom of information publication 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. Abstract Aims To describe type 1 diabetes incidence in Scotland between 2006 and 2019. Published: 1 January 1994. The research states the increase will be driven by the world's ever . Here you'll find information about campaigns and projects we're running to raise awareness, improve care and provide help, support and information for people with diabetes and their families across Scotland. Our remission estimate therefore does not account for people whose diabetes was diagnosed on the basis of fasting glucose values or 2-hr PG alone and who never had a record of HbA1c 48 mmol/mol (6.5%) after diagnosis of diabetes. After stratification by age, the prevalence of remission in the study eligible population in 2019 was 3.2% in those aged <64 years and 6.0% in those aged 65 years. 2022 Oct 12;12(10):e063046. By 2045, it is estimated that there will be 700 million people in the world with diabetes. Cohort profile: the Scottish Diabetes Research Network national 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. As for all studies using routine data, missing data were fairly common, although the proportions of missing data in all covariates were low enough to justify the use of multiple imputation and findings from both complete and imputed datasets were similar. We used a period of 1 year rather than 6 months to define remission as HbA1c tends to be measured on an annual basis in Scotland, particularly among people whose diabetes is well controlled. Our estimates for prevalence of type 2 diabetes remission reflect the period prior to the widespread introduction of the use of very low calorie diets in routine clinical care and the COVID-19 pandemic so further estimates of remission prevalence estimates will be required in the future. ICD-10 and ICD-9 codes used to identify comorbidities. 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. However, as remission is implemented in routine care, further consideration is needed as to whether older people and/or people with unintentional weight loss constitute a subset of people in remission or whether future iterations of the remission definition should exclude these groups by specifying that weight loss must be intentional. The University of Edinburgh, Western General Hospital Crewe Road South Edinburgh EH4 2XU . Following complete cessation of all GLT. [4] (p. 74). American Diabetes Association;AHEAD, Both studies found no association between BMI at diagnosis of type 2 diabetes and remission. 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). 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. The SDRNT1BIO is a research collaboration involving researchers, clinicians and people with diabetes. Share This article was published on 1 Apr, 2021 In conclusion, we have shown that approximately 5% of people with type 2 diabetes in Scotland in 2019 appear to be in remission and that history of never having GLT, weight loss since diagnosis, HbA1c <48 mmol/mol (6.0%) at diagnosis, age 65 years, and previous bariatric surgery are associated with remission. Further research is needed to investigate the association between remission and complications of diabetes including mortality. Poster presentation at the 51, Looker H, Livingstone S, McGurnaghan S, Collier A, Green F, Lindsay RS, MacRury S, McKnight JA, Milburn K, Palmer CAN, Patrick AW, Pearson DWM, Pearson ER, Petrie JR, Thekkepat S, Walker J, Colhoun HM, on behalf of the SDRNT1BIO investigators. The lack of history of GLT prescription had a particularly strong association with remission. 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. A 70% increase in prevalent cases of T1DM in those aged under 15 years in Europe between 2005 and 2020 is predicted. You can give permission for any leftover blood samples, taken by your doctor, to be stored and used for future research. Cohort Profile: Scottish Diabetes Research Network Type 1 Bioresource 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. There's a lot of ways to get involved with us. This nonsurgical approach has the potential to make remission of type 2 diabetes more widely feasible without the adverse long-term effects of bariatric surgery. 2004;27(5):104753. Of these, 35,321 (17%) did not have any HbA1c records for 2019 and a further 9,219 (4.5%) never had a record of an HbA1c value 48 mmol/mol (6.5%), leaving 162,316 people for the primary analysis, of whom 117,048 (72%) had complete data. We carried out a cross-sectional study estimating the prevalence of remission of type 2 diabetes in all adults in Scotland aged 30 years diagnosed with type 2 diabetes and alive on December 31, 2019. Primary Care Diabetes Society;SCI-Diabetes, The major focus for endocrine research is within the British Heart Foundation Centre for Cardiovascular Science (Deputy Director - Professor Rebecca Reynolds): Centre for Cardiovascular Science website. Our Staff | NHS Research Scotland | NHS Research Scotland S2 Fig. Characteristics of people who were in remission in 2019 compared to people who were not in remission of type 2 diabetes among people in Scotland who had at least 1 HbA1c 48 mmol/mol (6.5%) after diagnosis of type 2 diabetes and had at least 1 HbA1c recorded in 2019. 29 June, 2023 14:43. Serum samples have been used for the measurement of several biomarkers of interest including C-peptide, serum creatinine and auto-antibodies (GAD, ZnT8, IA2). Coronavirus Disease 2019;DiRECT, Our findings can be used to evaluate the impact of future initiatives on the prevalence of type 2 diabetes remission. Relationship between urinary neopterin excretion and islet cell antibodies in type 1 (insulin-dependent) diabetes.. 17. A total of 7,710 people (4.8% [95% confidence interval [CI] 4.7 to 4.9]) were in remission of type 2 diabetes. There were an estimated 463 million people with diabetes in the world in 2019, of whom 90% to 95% have type 2 diabetes [1]. The Queen spoke with Professor Lucy Walker, right, during her visit (Justin Tallis/PA) The Queen donned a white lab coat to learn about pioneering new research into type 1 . Find out more about the Diabetes Scotland team. IDF Diabetes Atlas 2019 [24.08.2020]. Poster presentation at the 77, Bermingham ML, Colombo M, McGurnaghan S, Blackbourn L, Vukovi F, Pui Bakovi M, Lauc G, Agakov FA, Agakov AS, Hayward C, Klaric L, McKeigue PM, Colhoun HM, SDRNT1BIO investigators. Our study additionally found that weight loss was strongly associated with remission, which was not examined by Karter and colleagues. confidence interval;COVID-19, Clinicians also need greater clarity on how to manage older or frailer people who achieve remission criteria. Unless explicitly stated otherwise, all material is copyright The University of Edinburgh 2023. This was an exploratory cross-sectional analysis for which there was no . The availability of the home monitoring results may give professionals more confidence in their assessment of the effectiveness of the patients self-care and medication and lead to effective regimens being established more quickly. S4 Fig. Odds of remission were statistically significantly higher in people aged 65 to 74 and 75 years compared to people aged 46 to 54 years (Fig 3, S5 Table).
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