Incidence and predictors of remission and relapse of type 2 diabetes mellitus in Japan: Analysis of a nationwide patient registry

Aims To determine the incidence of remission and 1-year relapse from remission and associated factors in patients with type 2 diabetes.Materials and methods A total of 48 320 Japanese patients with type 2 diabetes aged =18 years, with glycated haemoglobin (HbA1c) levels = 48 mmol/mol (6.5%) and/or glucose-lowering drug prescription, were identified from databases of specialist clinics from 1989 and followed until September 2022. Remission was defined as HbA1cThe overall incidence of remissions per 1000 person-years was 10.5, and for those with HbA1c levels of 48 to 53 mmol/mol (6.5% to 6.9%), those taking no glucose-lowering drugs at baseline, and those with a =10% body mass index (BMI) reduction in 1 year, it was 27.8, 21.7 and 48.2, respectively. Shorter duration, lower baseline HbA1c, higher baseline BMI, higher BMI reduction at 1 year, and no glucose-lowering drugs at baseline were significantly associated with remission. Among 3677 persons with remission, approximately two-thirds (2490) relapsed within 1 year. Longer duration, lower BMI at baseline, and lower BMI reduction at 1 year were significantly associated with relapse.Conclusions The results showed that the incidence of remission and predictors of relapse, especially baseline BMI, might differ greatly between East Asian and Western populations. Furthermore, the relationships of BMI reduction with remission and relapse may be greater in East Asian than in Western populations, implying ethnic differences in returning from overt hyperglycaemia to nearly normal glucose levels.

Automated summary

This study aimed to determine the incidence of remission and 1-year relapse in patients with type 2 diabetes and associated factors. The overall incidence of remission in Japanese patients was 10.5 per 1000 person-years, with higher rates for those with HbA1c levels of 48 to 53 mmol/mol (6.5% to 6.9%), those taking no glucose-lowering drugs at baseline, and those with a =10% BMI reduction in 1 year. Shorter duration, lower baseline HbA1c, higher baseline BMI, greater BMI reduction at 1 year, and no glucose-lowering drugs at baseline were significantly associated with remission. Among those with remission, approximately two-thirds relapsed within 1 year. Longer duration, lower baseline BMI, and lower BMI reduction at 1 year were significantly associated with relapse.