Type 2 Diabetes 'Remission' Is a Reality, Say Major Organiza
A new joint consensus statement by four major diabetes organizations aims to standardize the terminology, definition, and assessment to the phenomenon of diabetes "remission."

The statement was jointly issued by the American Diabetes Association, the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK.

The group define "remission" — whether attained via lifestyle, bariatric surgery, or other means — as an A1c less than 6.5% (less than 48 mmol/mol) at least 3 months after cessation of glucose-lowering pharmacotherapy. The panel also suggest monitoring individuals experiencing diabetes remission and raise questions that need further attention and study.

The statement recommends the following:

1. The term "remission" should be used to describe a sustained metabolic improvement in type 2 diabetes to near normal levels. The panel agreed the word strikes the best balance, given that insulin resistance and beta-cell dysfunction may still be present despite normoglycemia. "Diabetes doesn't get cured. The underlying abnormalities are still there. Remission is defined by glucose," Riddle said. The panel also decided to do away with ADA's former terms "partial", "complete", and "prolonged" remission because they are ambiguous and unhelpful.

2. Remission should be defined as a return to an A1c of less than 6.5% (less than 48 mmol/mol) — the threshold used to diagnose diabetes — spontaneously or following an intervention and that persists for at least 3 months in the absence of usual glucose-lowering medication.

3. When A1c may be unreliable, such as conditions involving variant hemoglobin or erythrocyte survival alterations, acceptable alternatives are a fasting blood glucose less than 126 mg/dL (less than 7.0 mmol/L) or an estimated A1c less than 6.5% calculated from continuous glucose monitoring data.

4. A1c testing to document a remission should be performed just prior to an intervention and no sooner than 3 months after initiation of the intervention and withdrawal of any glucose-lowering medication.

5. Subsequent ongoing A1c testing should be done at least yearly thereafter, along with routine monitoring for diabetes-related complications, including retinal screening, renal function assessment, foot exams, and cardiovascular risk factor testing. "At present, there is no long-term evidence indicating that any of the usually recommended assessments for complications can safely be discontinued," the authors write.

6. Research based on the terminology and definitions in the present statement is needed to determine the frequency, duration, and effects on short- and long-term medical outcomes of type 2 diabetes remissions using available interventions.

Source: https://care.diabetesjournals.org/content/early/2021/08/17/dci21-0034
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