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©The Author(s) 2024.
World J Methodol. Dec 20, 2024; 14(4): 95210
Published online Dec 20, 2024. doi: 10.5662/wjm.v14.i4.95210
Published online Dec 20, 2024. doi: 10.5662/wjm.v14.i4.95210
Table 1 Various terminologies used
Terminology | Word meaning | Blood sugar target for remission | Pathophysiological status | Follow-up |
Resolution | The subsidence of a pathological state | Attained | Permanent normalization | No |
Cure | A complete or permanent solution | Attained | Permanent normalization | No |
Reversal | A change from one state to the opposite state | Attained | Permanent normalization | No |
Remission | An abatement or reduction in intensity or degree (as in the manifestations of a disease) | Attained | Improvement | Yes |
Table 2 Diagnostic criteria for remission of type 2 diabetes mellitus
A: Establishing the diagnosis of T2DM/pre-diabetes | ||||
Documented evidence of T2DM based on established criteria like ADA criteria | ||||
Diagnosis | HbA1c | FPG | 2-h PG | |
T2DM | ≥ 6.5%; ≥ 48 mmol/mol | ≥ 126 mg/dL; ≥ 7 mmol/L | ≥ 200 mg/dL; ≥ 11.1 mmol/L | |
Pre-diabetes | 5.7% to 6.4%; 39 to 47 mmol/mol | 100 to 125 mg/dL; 5.6 to 6.9 mmol/L | 140 to 199 mg/dL; 7.8 to 11.0 mmol/L | |
B: Evidence of maintenance of blood sugar below the threshold for T2DM or normal range (biochemical remission) in people with established T2DM even after the withdrawal of pharmacotherapy/active intervention | ||||
Remission | HbA1c | FPG | 2-h PG | |
Partial | 5.7% to 6.4%; 39 to 47 mmol/mol | 100 to 125 mg/dL; 5.6 to 6.9 mmol/L | 140 to 199 mg/dL; 7.8 to 11.0 mmol/L | |
Complete | < 5.7%; < 39 mmol/mol | < 100 mg/dL; < 5.6 mmol/L | < 140 mg/dL; < 7.8 mmol/L | |
One or more components needed to establish remission | ||||
C: Duration criteria for the intervention and for the test | ||||
Normoglycemia persists even after the withdrawal of glucose-lowering intervention (pharmacotherapy/active intervention), which is documented after a reasonable washout period | ||||
Glucose-lowering intervention can be non-pharmacological (medical nutrition therapy or physical activity) or pharmacological intervention (medication or surgical intervention) | ||||
No ongoing pharmacological or surgical procedure (ongoing procedures like repeated placement of endoluminal devices or intragastric balloon) | ||||
If any medication that can reduce blood sugar is continued for non-glycemic indication, it is considered incomplete remission | ||||
Duration criteria for the intervention | ||||
Drugs after washout period (after five t ½ of the drug) | ||||
Lifestyle modification takes 3-6 mo to stabilize its effect | ||||
Duration criteria for the tests | ||||
HbA1c after 3 mo of washout period of intervention | ||||
FBS/PPBS/RBS/CGM after 24 h of washout period of intervention | ||||
Duration of remission is a retrospective assessment. Depending upon the duration of remission | ||||
Normoglycemia persisting | ||||
3-6 mo: Transient remission | ||||
6 mo-1 yr: Short-term remission | ||||
1-5 yr: Long-term remission | ||||
More than 5 yr: Prolonged remission | ||||
D: Evidence of improvement of the pathophysiological mechanism | ||||
Improvement in insulin resistance and β cell function | ||||
Indirect evidence of this is significant weight loss, about 15 kg | ||||
E: Satisfy exclusion criteria | ||||
Normalization of blood sugar value in people with T2DM is not due to any complications (e.g., nephropathy or hepatic dysfunction) or comorbid disease that causes reduced appetite, weight loss, or hypoglycemia (e.g., sepsis, adrenal or pituitary disease, malignancy) | ||||
Exclusion of stress hyperglycemia, gestational diabetes, or transient hyperglycemia | ||||
Exclusion of hyperglycemia due to any medications: Drug-induced diabetes (e.g., steroid, anti-malarial drugs, atypical antipsychotics, protease inhibitors) |
Table 3 Interpretation of proposed criteria for remission of type 2 diabetes mellitus
Diagnosis of T2DM/pre-diabetes | Evidence of biochemical remission | Antidiabetic treatment/ongoing intervention | Duration criteria | Reversal of pathophysiologic mechanism | Exclusion criteria | Interpretation |
Yes | Complete | No | + | + | + | Complete remission |
Partial | Partial remission | |||||
Yes | Complete | Yes, but for non-glycemic indication | + | + | + | Incomplete remission |
Partial | Incomplete partial remission | |||||
No | Complete/partial | No | +/- | +/- | +/- | Transient hyperglycemia. No remission. Improvement in risk factors |
Yes | Complete/partial | No | + | - | + | State of mitigation/T2DM mitigation |
- Citation: Raveendran AV. Remission of type 2 diabetes mellitus: Emerging concepts and proposed diagnostic criteria. World J Methodol 2024; 14(4): 95210
- URL: https://www.wjgnet.com/2222-0682/full/v14/i4/95210.htm
- DOI: https://dx.doi.org/10.5662/wjm.v14.i4.95210