Incidence of Remission in Adults With Type 2 Diabetes: The Diabetes & Aging Study
Open accessAbstract
OBJECTIVE: To estimate the incidence of remission in adults with type 2 diabetes not treated with bariatric surgery and to identify variables associated with remission. RESEARCH DESIGN AND METHODS: We quantified the incidence of diabetes remission and examined its correlates among 122,781 adults with type 2 diabetes in an integrated healthcare delivery system. Remission required the absence of ongoing drug therapy and was defined as follows: 1) partial: at least 1 year of subdiabetic hyperglycemia (hemoglobin A1c [HbA1c] level 5.7–6.4% [39–46 mmol/mol]); 2) complete: at least 1 year of normoglycemia (HbA1c level <5.7% [<39 mmol/mol]); and 3) prolonged: complete remission for at least 5 years. RESULTS: The incidence density (remissions per 1,000 person-years; 95% CI) of partial, complete, or prolonged remission was 2.8 (2.6–2.9), 0.24 (0.20–0.28), and 0.04 (0.01–0.06), respectively. The 7-year cumulative incidence of partial, complete, or prolonged remission was 1.47% (1.40–1.54%), 0.14% (0.12–0.16%), and 0.007% (0.003–0.020%), respectively. The 7-year cumulative incidence of achieving any remission was 1.60% in the whole cohort (1.53–1.68%) and 4.6% in the subgroup with new-onset diabetes (<2 years since diagnosis) (4.3–4.9%). After adjusting for demographic and clinical characteristics, correlates of remission included age >65 years, African American race, <2 years since diagnosis, baseline HbA1c level <5.7% (<39 mmol/mol), and no diabetes medication at baseline. CONCLUSIONS: In community settings, remission of type 2 diabetes does occur without bariatric surgery, but it is very rare.
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Despite a mean and median of 8.4 and 7 years since diagnosis among CCI participants, the remission rate was higher than the Look AHEAD trial where its participants had a median of 5 years since diabetes diagnosis.
“Despite a mean and median of 8.4 and 7 years since diagnosis among CCI participants, the remission rate was higher than the Look AHEAD trial where its participants had a median of 5 years (4) since diabetes diagnosis.”
From Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial (2019) · cites this paper as [4]
The Conclusions compare remission rates with Look AHEAD and state that this paper's cohort had a longer duration of diabetes than Look AHEAD participants. They do not give a median of 5 years since diagnosis for Look AHEAD, the specific figure to which citation (4) is attached. The Results give a 5.9-year median for this paper's own cohort, not for Look AHEAD. (LLM, conf=0.83)
Experimental — accuracy not yet measuredPrevious studies consistently report that weight loss increases the likelihood of T2D remission.
“Previous studies consistently report that weight loss increases the likelihood of T2D remission (4, 5, 9).”
From Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial (2019) · cites this paper as [4]
The Conclusions (page unavailable) report that a change in BMI predicted remission in the Look AHEAD study, which lends some support to a weight-change association. But the passage does not specify that weight loss increased the likelihood of remission, and this paper’s own association between lower baseline BMI and remission did not persist after adjustment. It therefore does not establish the claimed consistency across previous studies. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPartial and complete remission rates of 2.4 and 0.2% per year, respectively, were reported in 122,781 T2D patients receiving standard diabetes care.
“Partial and complete remission rates of 2.4 and 0.2% per year, respectively, were reported in 122,781 T2D patients receiving standard diabetes care (4).”
From Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial (2019) · cites this paper as [4]
The Abstract (Research Design and Methods) identifies 122,781 adults with type 2 diabetes, and the Introduction says they received usual care. But Table 3 (Results) reports partial and complete remission rates of 2.75 and 0.24 per 1,000 person-years—approximately 0.275% and 0.024% per year—not 2.4% and 0.2% per year. (LLM, conf=0.93)
Experimental — accuracy not yet measuredTwenty percent of participants in diabetes remission after five years under care in the present investigation exceeds the observed prevalence of remission in usual care and compares favorably with other lifestyle therapies.
“Twenty percent of participants in diabetes remission after five years under care in the present investigation exceeds the observed prevalence of remission in usual care where glucose management with medication tends to be the predominant treatment focus [27] and compares favorably with other lifestyle therapies which have elicited remission.”
Length of time with a T2D diagnosis is a factor in remission, with longer time since diagnosis resulting in lower remission.
“Length of time with a T2D diagnosis is a factor in remission, with longer time since diagnosis resulting in lower remission (4, 5, 9).”
The remission rate under usual care is 0.5-2%.
“The remission rate under usual care is 0.5–2% (4)”
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- Authors
- Karter, A. J., Nundy, S., Parker, M. M., Moffet, H. H., & Huang, E. S.
- Affiliations
- Kaiser Permanente (US)
- George Washington University (US)
- University of Chicago (US)
- Corresponding author
- Karter, Andrew J.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2014-11-08
- Volume
- 37
- Issue
- 12
- Pages
- 3188-3195
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4237974
- OpenAlex
- W2169358405
- Cited by
- 132
- References
- 40
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 14 · 2023: 11 · 2022: 13 · 2021: 16 · 2020: 8 · 2019: 16 · 2018: 8 · 2017: 8 · 2016: 4 · 2015: 8
- FWCI
- 5.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kaiser Permanente
- University of Chicago
- Agency for Healthcare Research and Quality (T32 HS00084, T32HS000084)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK080726, R01DK081796, R01DK065664, P30DK092949, P30DK092924)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD046113)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- type 2 diabetes, diabetes remission, HbA1c, normoglycemia, new-onset diabetes, age, African American race, antidiabetic drugs, community-based cohort, integrated health system
- MeSH terms
- Adult, Aged, Aging, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Remission Induction, Cohort Studies, Incidence, Bariatric Surgery
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