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ABCD and PCDS produce type 2 diabetes remission definition

By Editor
6th March 2019
Guidelines, Type 2 diabetes Type 2 prevention

A clinical definition of type 2 diabetes remission has been created by two leading professional groups.

The Association of British Clinical Diabetologists (ABCD) and the Primary Care Diabetes Society (PCDS) have teamed up to produce a position statement on the reversal of the condition.

In the consensus document, the groups say they have put together a “practical definition of remission of type 2 diabetes” in the absence of any single internationally-acceptable description.

The statement has also called for “consistent coding” for remission of the condition to facilitate safe follow-up and data collection in routine clinical practice.

ABCD and PCDS strongly recommended that “diabetes resolved” clinical codes should not be employed in clinical practice but that “diabetes in remission” codes should preferentially be adopted.

Recommended definition

The definition states: “Remission of type 2 diabetes can be diagnosed when a person with confirmed type 2 diabetes has achieved all three of the following criteria: (i) Weight loss; (ii) Fasting plasma glucose or HbA1c below the WHO diagnostic threshold (<7mmol/l or <48mmol/mol, respectively) on two occasions separated by at least 6 months; (iii) the attainment of these glycaemic parameters following the complete cessation of all glucose-lowering therapies.”

The document was put together by first author and chair of ABCD Dr Dinesh Nagi, a Consultant in Diabetes and Endocrinology at Mid Yorkshire NHS Trust, along with Dr Clare Hambling, GP and PCDS chair, and Professor Roy Taylor, from Newcastle University.

They stated: “We acknowledge that there is considerable debate in the scientific community about the duration over which HbA1c or fasting plasma glucose levels must be maintained to define remission. However, we have adopted a pragmatic approach, believing six months to be a reasonable duration, aimed at encouraging motivation and sustained weight loss to achieve remission over a longer period.”

ABCD and PCDS are now calling for other societies to come together to work with us to agree an internationally-agreed definition to allow for a global platform for further research and data collection.

Other key messages from the position statement include:

  • There is ample evidence to support the statement that it is possible to achieve remission in type 2 diabetes.
  • ABCD and PCDS recognise the importance of a consensus definition, which has significant implications for people who achieve remission of type 2 diabetes, as well as health services.
  • In responsive individuals, where type 2 diabetes is associated with weight gain or obesity, remission in type 2 diabetes can be achieved through several means and all require a sustainable weight loss. This is particularly true in the early stages of type 2 diabetes when irreversible damage to the beta cell has not happened.
  • Once achieved, remission must be sustained to gain the full health benefits.
  • Of the various strategies shown to be effective, weight loss through bariatric surgery or low calorie diet, remain the most successful methods. Both require ongoing sustained modest restriction of energy intake and increase in daily physical activity.
  • The groups acknowledge that weight loss achieved by any means, including unintentional weight loss, may contribute to remission of type 2 diabetes.
  • Implicit in defining remission is that biochemical parameters must have been achieved and maintained following the discontinuation of all glucose-lowering therapies.
  • It is important, that in those individuals who achieve and sustain remission, robust systems are in place to call and recall these individuals for annual review and that primary care is adequately resourced to facilitate this.

To access ‘Remission of Type 2 Diabetes: A Position Statement from the Association of British Clinical Diabetologists (ABCD) and the Primary Care Diabetes Society (PCDS)’, click here.

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