Experts agree new medical definition of 'diabetes remission'

Major progress made in the treatment of type 2 diabetes has prompted a new medical definition of ‘diabetes remission’.

As a result of the increasing number of people who are achieving diabetes remission, the American Diabetes Association convened an international, multidisciplinary expert group to review the medical guidelines and definitions around this topic.

The report of this expert group has now been published and it recommends that the term ‘remission’ should be used rather than the term ‘cure’.

“This can be identified when blood sugar levels return to below the level indicative of diabetes (HbA1c <48mmol/mol), continue for at least three months, and without the use of medications,” explained expert group member, Prof Carel le Roux, who is also a spokesperson for the Irish Society for Clinical Nutrition and Metabolism (IrSPEN).

He emphasised that treatments for type 2 diabetes have undergone major transformation, with different therapies succeeding in normalising blood glucose levels in certain people.

“These treatments reverse the toxicity of high blood glucose levels to specific organs and this has prompted the re-evaluation of terminology and definitions of remission of diabetes to guide doctors. This development reflects very positive progress for patients and our health system,” he said.

Currently in Ireland, type 2 diabetes affects one in 15 people, but consumes over 10% of the entire health budget.

Prof le Roux added that testing to determine long-term maintenance of remission should be undertaken annually, together with routine testing for potential complications.

According to IrSPEN spokesperson and UCD chair of surgery at St Vincent’s University Hospital, Prof Helen Heneghan, language is key when it comes to this issue.

“Language around diabetes definition is critical and there is a need for the accuracy which this medical consensus report has provided,” she commented.

She pointed out that a return to normal blood glucose levels in patients with typical type 2 diabetes can now be attained “by several therapies, which is very positive for patients”.

“However, the frequency of sustained improvement, its likely duration and its effect on subsequent medical outcomes remain unclear for now, but research underway here in Ireland will help answer these questions,” Prof Heneghan said.

Meanwhile, according to IrSPEN spokesperson and bariatric surgeon at St Vincent’s Private Hospital, Mr Dimitri Pournaras, while bariatric surgery was the first to show that remission of diabetes was possible, “the future for people living with type 2 diabetes has never been brighter given our ability to now combine nutritional therapies, pharmacotherapies and surgical therapies”.

The international expert group also included representatives from the European Association for the Study of Diabetes, Diabetes UK, the Endocrine Society and the Diabetes Surgery Summit. The report of the expert group is published in the Journal of Clinical Endocrinology & Metabolism and can be viewed here.