This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
This analysis included data on 60,287 people with type 2 diabetes; follow up was 7 years on average. The study found that those who achieved remission from diabetes, even for a short time:
- had a much lower risk of cardiovascular disease, including heart attack and stroke
- had a much lower risk of large and small blood vessel complications (including peripheral arterial disease and damage to eyes and kidneys).
For people who achieved remission, even if they relapsed, these risks were less than half (compared with people who had consistently high blood sugar levels). The findings should reassure clinicians and people with type 2 diabetes that even short-term remission is linked with long-term health benefits.
For more information on type 2 diabetes, visit the NHS website.
The issue: does short-term remission from diabetes have health benefits?
More than 3.8 million people in the UK have type 2 diabetes, which means their blood sugar levels are too high. People with the condition are more likely to have cardiovascular events (including stroke, heart attack or amputation). It is also linked with large blood vessel complications (including cardiovascular events and peripheral arterial disease) and small blood vessel complications (including damage to nerves, eyes or kidneys).
Lifestyle changes including weight loss and exercise can reduce blood sugar levels and lead to remission from diabetes. Diabetes remission means that people control their blood sugar levels (HbA1c less than 6.5% / 48 mmol/mol) without the help of medication. However, over time, some regain weight and relapse into type 2 diabetes.
Researchers assessed whether diabetes remission, even for a short period, reduces people’s long-term risk of cardiovascular disease.
What’s new?
The analysis was based on the medical records of 60,287 people with type 2 diabetes from 150 GP practices in Southern England. Participants’ average age was 65 and more than half (57%) were male. Over an average of 7 years, 19% achieved remission for at least 6 months (HbA1c less than 6.5% / 48 mmol/mol) without the help of medication or weight loss surgery.
The researchers grouped people according to the broad pattern of their blood sugar control. They considered groups that:
- achieved remission and did not relapse (15%)
- achieved remission and then relapsed (14%)
- decreased their blood sugar levels but did not achieve remission (11%)
- had consistently high blood sugar levels and did not achieve remission (61%).
Over the study period, 7% people had a cardiovascular event, 8% had a large blood vessel complication, 26% had a small blood vessel complication, and 12% died. The researchers explored whether these events were more likely in some groups than others. They adjusted results for sex, age, ethnicity, and other factors.
Compared with people who had consistently high blood sugar levels, people who achieved remission, even if they later relapsed, were:
- less likely to have a cardiovascular event (76% less likely without relapse; 71% with relapse)
- less likely to have a large blood vessel complication (85% less likely without relapse; 70% with relapse)
- less likely to have a small blood vessel complication (63% less likely without relapse; 56% with relapse).
People who decreased their blood sugar levels but did not achieve remission were less likely to have small blood vessel complications than those who had consistently high blood sugar levels, but similarly likely to have a cardiovascular event.
In a pooled analysis, people who achieved remission at any point had a lower risk of death compared with people who did not achieve remission and had consistently high blood sugar levels.
However, a separate individual analysis found that people who achieved remission and did not relapse were more likely to die than people who had consistently high blood sugar levels. The researchers say that many in this group (who achieved remission and did not relapse) had large reductions in their weight, which could have been due to other conditions such as cancer.
Why is this important?
The study shows that remission is linked with a lower risk of cardiovascular complications. This should reassure people with type 2 diabetes and clinicians that achieving remission is possible and has long-term health benefits.
Data on blood sugar levels were missing for almost half the participants. The researchers caution that they demonstrated a link between remission and a reduced risk of cardiovascular disease; other factors such as weight and age also influence risk.
What’s next?
The authors will be using these findings to develop tailored interventions to support people to achieve remission.
You may be interested to read
This is a summary of: Dambha-Miller H, and others. Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study. PLoS ONE 2023; 18. DOI: 10.1371/journal.pone.0290791.
Information on type 2 diabetes from Diabetes UK.
A related study showing that remission is linked with a lower risk of cardiovascular disease: Hounkpatin HO, and others. Association of type 2 diabetes remission and risk of cardiovascular disease in pre-defined subgroups. Endocrinology, Diabetes & Metabolism 2021. DOI: 10.1002/edm2.280.
Information on taking part in NIHR research on type 2 diabetes.
Funding: The study was supported by the NIHR School of Primary Care Research.
Conflicts of Interest: None declared.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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