The Association of British Clinical Diabetologist (ABCD) and the Primary Care Diabetes Society (PCDS) have come together to call for a unified definition of type 2 diabetes remission.
The proposal formulated by Dr Dinesh Nagi chair of ABCD, Dr Clare Hambling chair of PCDS and Professor Roy Taylor highlights the need for improved clarity and consistency regarding how type 2 diabetes remission is defined, as there is currently no international or even nationally agreed definition.
It is being increasingly recognised that individuals with type 2 diabetes who are obese or overweight and manage to achieve substantial weight loss, could put type 2 diabetes into remission.
The one-year findings from our award-winning Low Carb Program have found that 26% achieved remission, defined as reducing HbA1c into normal levels while taking no glucose-lowering medications or just metformin.
It has been hard though to pin down an exact definition of what remission means. For one thing, remission can be achieved in a variety of ways, such as through low carb, low calorie (as evidenced in the DiRECT study) and bariatric (weight loss) surgery.
Previous attempts have seen terms such as partial, complete and prolonged remission being suggested to incorporate the varying timeframes over which individuals may show signs of remission.
This fragmented approach has been deemed too complex to incorporate into clinical practice. A new, clearer definition could help minimise any confusion for individuals working to achieve remission and for healthcare practitioners in how to monitor long-term progress.
The new proposal sees remission achieved once three key criteria are met:
- Weight loss
- Achieving a fasting plasma glucose(<7mmol/l) or HbA1c(<48mmol/mol) under the WHO diagnostic guidelines on 2 occasions separated by at least 6 months.
- Achieving the above once completely stopping any blood glucose lowering medications
This simplified, single definition reinforces the need to sustain long-term changes to weight and blood glucose levels.
Under the new consensus ABCD and PCDS also suggest a change in the coding of diabetes in remission during medical practice, with a new code ‘diabetes in remission’ being used to identify patients. Again, they hope this will help improve future data and allow healthcare providers to have clear guidelines.
This step forward in recognising a remission definition provides hope that soon there could be more consistency when identifying patients in remission, which will inevitably help support future data collection and medical practice.