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Diabetes Remission Definition

Characteristics And Determinants Of Partial Remission In Children With Type 1 Diabetes Using The Insulin-dose-adjusted A1c Definition

Characteristics And Determinants Of Partial Remission In Children With Type 1 Diabetes Using The Insulin-dose-adjusted A1c Definition

Copyright © 2014 Aurore Pecheur et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract To evaluate the characteristics and determinants of partial remission (PR) in Belgian children with type 1 diabetes (T1D), we analyzed records of 242 children from our center. Clinical and biological features were collected at diagnosis and during follow-up. PR was defined using the insulin-dose-adjusted A1C definition. PR occurred in 56.2% of patients and lasted 9.2 months (0.5 to 56.6). 25.6% of patients entered T1D with DKA, which correlated with lower PR incidence (17.6% versus 82.3% when no DKA). In our population, lower A1C levels at diagnosis were associated with higher PR incidence and in young children (0–4 years) initial A1C levels negatively correlated with longer PR. Early A1C levels were predictive of PR duration since 34% of patients had long PRs (>1 year) when A1C levels were ≤6% after 3 months whereas incidence of long PR decreased with higher A1Cs. C-peptide levels were higher in patients entering PR and remained higher until 3 years after diagnosis. Initial antibody titers did not influence PR except for anti-IA2 titers that correlated with A1C levels after 2 years. Presence of 2 versus 1 anti-islet antibodies correlated with shorter PR. PR duration did not influence occurrence of severe hypoglycemia or diabetes-related complications but was associated with lower A1C levels after 18 months. We show that, at diagnosis of T1D, parameters associated with -cell mass reserve (A1C, C-peptide, and DKA) correlate with the occurrence of PR, which affects post-PR A1C levels. Further research is need Continue reading >>

How Do We Define Cure Of Diabetes?

How Do We Define Cure Of Diabetes?

The mission of the American Diabetes Association is “to prevent and cure diabetes and to improve the lives of all people affected by diabetes.” Increasingly, scientific and medical articles (1) and commentaries (2) about diabetes interventions use the terms “remission” and “cure” as possible outcomes. Several approved or experimental treatments for type 1 and type 2 diabetes (e.g., pancreas or islet transplants, immunomodulation, bariatric/metabolic surgery) are of curative intent or have been portrayed in the media as a possible cure. However, defining remission or cure of diabetes is not as straightforward as it may seem. Unlike “dichotomous” diseases such as many malignancies, diabetes is defined by hyperglycemia, which exists on a continuum and may be impacted over a short time frame by everyday treatment or events (medications, diet, activity, intercurrent illness). The distinction between successful treatment and cure is blurred in the case of diabetes. Presumably improved or normalized glycemia must be part of the definition of remission or cure. Glycemic measures below diagnostic cut points for diabetes can occur with ongoing medications (e.g., antihyperglycemic drugs, immunosuppressive medications after a transplant), major efforts at lifestyle change, a history of bariatric/metabolic surgery, or ongoing procedures (such as repeated replacements of endoluminal devices). Do we use the terms remission or cure for all patients with normal glycemic measures, regardless of how this is achieved? A consensus group comprised of experts in pediatric and adult endocrinology, diabetes education, transplantation, metabolism, bariatric/metabolic surgery, and (for another perspective) hematology-oncology met in June 2009 to discuss these issues. The group con Continue reading >>

Diabetes In Remission

Diabetes In Remission

Bernard: ‘I have lost 30 kg (66 lbs) and I look and feel so much better… Today I am cured of diabetes.’1 ‘Millions of people suffering from Type 2 diabetes could be cured of the disease if they just lost weight, a new study suggests.’2 If we are ill we want to be cured. We want our illness to vanish completely and never return. Is this possible with diabetes? Patients and the media seem to think so. I am not so sure. What is diabetes? See Box 1. Diabetes is diagnosed on laboratory confirmation of hyperglycaemia. Glucose is a continuum. It is challenging to decide which diagnostic test for glycaemia to use. Normoglycaemia alone does not define freedom from diabetes – otherwise anyone who achieves this on medication could say they were ‘cured’. Normoglycaemia off all glucose-lowering medication for some time could be said no longer to fulfil the diagnostic criteria. But hyperglycaemia is only one component of diabetes. There are more distressing and damaging problems. Box 1. Definitions of diabetes The microvascular complications of diabetes – retinopathy, neuropathy and nephropathy – are thought to be virtually specific to diabetes. People with diabetes are at risk of damage to every major body system. A person with diabetes with prolonged normoglycaemia off all hypoglycaemic medication may still have the damage inflicted by past hyperglycaemia. New microvascular disease, for example retinopathy, can appear months or years later. Definition of remission in diabetes There is no recent definition. A US consensus group suggested the definition in Box 2. They state: ‘The distinction between successful treatment and cure is blurred in the case of diabetes.’3 Box 2. Diabetes in remission: 2009 American consensus statement3 The old Read code for ‘diabe Continue reading >>

How Do We Define Cure Of Diabetes?

How Do We Define Cure Of Diabetes?

The mission of the American Diabetes Association is “to prevent and cure diabetes and to improve the lives of all people affected by diabetes.” Increasingly, scientific and medical articles (1) and commentaries (2) about diabetes interventions use the terms “remission” and “cure” as possible outcomes. Several approved or experimental treatments for type 1 and type 2 diabetes (e.g., pancreas or islet transplants, immunomodulation, bariatric/metabolic surgery) are of curative intent or have been portrayed in the media as a possible cure. However, defining remission or cure of diabetes is not as straightforward as it may seem. Unlike “dichotomous” diseases such as many malignancies, diabetes is defined by hyperglycemia, which exists on a continuum and may be impacted over a short time frame by everyday treatment or events (medications, diet, activity, intercurrent illness). The distinction between successful treatment and cure is blurred in the case of diabetes. Presumably improved or normalized glycemia must be part of the definition of remission or cure. Glycemic measures below diagnostic cut points for diabetes can occur with ongoing medications (e.g., antihyperglycemic drugs, immunosuppressive medications after a transplant), major efforts at lifestyle change, a history of bariatric/metabolic surgery, or ongoing procedures (such as repeated replacements of endoluminal devices). Do we use the terms remission or cure for all patients with normal glycemic measures, regardless of how this is achieved? A consensus group comprised of experts in pediatric and adult endocrinology, diabetes education, transplantation, metabolism, bariatric/metabolic surgery, and (for another perspective) hematology-oncology met in June 2009 to discuss these issues. The group con Continue reading >>

Am I Cured Of Diabetes?

Am I Cured Of Diabetes?

When it comes to type 2 diabetes, these three words are everywhere: reversal, remission and cure. There are so many people who claim to have the answer to type 2 diabetes either through a diet plan or supplement. They claim to have a cure or that they can reverse your type 2. The argument that ensues takes offense at the idea that type 2 can be cured or reversed or even put into remission. I think that the evolution around these arguments stems from the irritation we feel when people tell us, “All you have to do is this…and you’re cured.” Sometimes, we get hypersensitive, and I’m as much to blame as anyone else. So let’s take a look at these three words. Here are the definitions taken from a medical dictionary: Reversal: a change to an opposite condition, direction, or position.Remission: a temporary or permanent decrease or subsidence of manifestations of a disease. Cure: a restoration of health; recovery from disease. Let’s say I’m someone who has type 2 diabetes (Hey! I DO have type 2 diabetes! Not much of a stretch, eh?) and I find a food plan that I think will work for me and I try it. I work hard at lowering my bg numbers. I exercise. I kick diabete’s butt. So now I have an A1c of 6.0 percent, which is pretty darn good for someone with diabetes. Based on the definitions above, have I reversed my diabetes or put it into remission? Am I cured? Well, I could say that it’s reversed because I have changed the direction of my disease. My blood glucose was going up and now it’s going down: reversal. I could also say that my diabetes is in remission because I have a decrease in the manifestations of the disease. As for cured, I may have restored my health but I have not recovered from the disease. In all three cases, diabetes is still there lurking, Continue reading >>

Defining A Practical Cure For Type 1 Diabetes

Defining A Practical Cure For Type 1 Diabetes

Defining a Practical Cure for Type 1 Diabetes >Free Media , Cure , Free Articles , Health-e-Connection | 8 comments Defining a Practical Cure for Type 1 Diabetes Many people have asked us why we do not use the cure word, or even Practical Cure for Type 1 Diabetes with our two boys. We have always been reluctant to use the C-wordbecause it can mean different things to each individual. In fact, it means different things to healthcare professionals and organizations too! However, there do seem to be some fundamental core values that most people hold when it comes to defining a practical cure for diabetes. It is quite surprising that the primary diabetes charities and research organizations do not have an easily-found, published definition of a cure for diabetes. I found a couple of good articles that I will use as assistance in defining a practical cure for diabetes. A new organization, called the Juvenile Diabetes Cure Alliance (JDCA) did some excellent investigation of the major Type 1 charities to discover their definition of a cure for type 1 diabetes. JDCAs diligence indicates that none of the major Type 1 diabetes charities have adopted a formal definition of a cure. Through diligence of the Type 1 landscape, the JDCA has found that none of the organizations within our coverage universe have adopted a formal definition of a cure. The JDCAs ongoing attentiveness to the Type 1 landscape includes reading all available years of annual reports and other literature, including donor materials, viewing the website, and contacting management of the major funders of Type 1 research. Please see our findings in Exhibit A. Some charities have developed a vision of a cure, but a vision is too vague to be meaningful when setting research strategies. (1) A consensus group comprised Continue reading >>

Doctors Are Unaware Of Type 2 Diabetes Remission, Study Reports

Doctors Are Unaware Of Type 2 Diabetes Remission, Study Reports

Scottish researchers have published a report calling for more doctors to realise that type 2 diabetes can be put into remission. Glasgow University scientists are trying to raise awareness among healthcare professionals that type 2 diabetes can be effectively treated, reducing the need for medication. They have penned a report in the British Medical Journal arguing that some doctors do not fully understand the benefits of weight loss and healthy eating and how it can lead to type 2 diabetes remission. "They are not treating the disease process, and are missing the point," said Professor Mike Lean. "Not only is type 2 diabetes preventable by not getting fat in the first place, but as long as you get in early after the disease is established - in the first five years or so - you have a better than even chance of becoming non-diabetic." Lean and colleagues believe awareness of the benefits which lead to remission is poor because it is rarely recorded officially. They referenced one US study where remission from type 2 diabetes was achieved in only 0.14 per cent of 120,000 patients over a seven-year period. "Lack of agreed criteria and guidance over recoding may have led to hesitation in coding remission, but the main reason for the low recording is probably that few patients are attempting or achieving remission," said the study authors. Meanwhile, our Low Carb Program has helped scores people with type 2 diabetes come off their medication. This was achieved through their commitment to eating a low-carb diet, which has shown in a myriad of studies to be effective in lowering the body's need for insulin, consequently helping people rely less on medication. Lean added: "It is in everybody's interest to reclassify people with type 2 diabetes when they become non-diabetic. Off Continue reading >>

Diabetes Remission Possible With Diet, Exercise

Diabetes Remission Possible With Diet, Exercise

December 18, 2012 / 9:50 PM / 5 years ago Diabetes remission possible with diet, exercise NEW YORK (Reuters Health) - One in nine people with diabetes saw their blood sugar levels dip back to a normal or pre-diabetes level after a year on an intensive diet and exercise program, in a new study. Complete remission of type 2 diabetes is still very rare, researchers said. But they added that the new study can give people with the disease hope that through lifestyle changes, they could end up getting off medication and likely lowering their risk of diabetes-related complications. Kind of a long-term assumption really is that once you have diabetes theres no turning back on it, and theres no remission or cure, said Edward Gregg, the lead author on the report from the Centers for Disease Control and Prevention. The research, he told Reuters Health, is a reminder that adopting a healthy diet, physically-active lifestyle and reducing and maintaining a healthy weight is going to help manage peoples diabetes better. His teams study cant prove the experimental program - which included weekly group and individual counseling for six months, followed by less frequent visits - was directly responsible for blood sugar improvements. The original goal of the research was to look at whether that intervention lowered participants risk of heart disease (so far, it hasnt). But the diabetes improvements are in line with better weight loss and fitness among people in the program versus those in a comparison group who only went to a few annual counseling sessions, Greggs team reported Tuesday in the Journal of the American Medical Association. About eight percent of people in the United States have diabetes, according to the American Diabetes Association. The new study included 4,503 of them wh Continue reading >>

Moving Goal Posts: Definition Of Diabetes Remission After Bariatric Surgery Ravindra S, Miras A - J Obes Metab Res

Moving Goal Posts: Definition Of Diabetes Remission After Bariatric Surgery Ravindra S, Miras A - J Obes Metab Res

The escalating twin pandemics of obesity and type 2 diabetes mellitus (T2DM) present a major global public health burden. Bariatric surgery is an effective treatment for obese patients with T2DM, as it not only causes weight loss, but also improves metabolic risk factors including glycemia, hypertension and dyslipidemia. Although several studies have shown impressive remission rates of T2DM following bariatric surgery, these studies have used different definitions of remission. In an attempt to solve the problem of inconsistent definitions, the American Diabetes Association and International Diabetes Federation, two large diabetes organizations, have developed standardized criteria for T2DM remission. These criteria are comprised of clinical parameters including glucose, lipid and blood pressure control and medication usage. Studies using these criteria have reported lower rates of remission than those previously reported using nonstandardized definitions. This review describes the existing literature on remission of T2DM following bariatric surgery, and emphasizes the importance of using the standardized definitions established in order to improve remission rates and thus reduce the incidence of the macrovascular and microvascular complications of T2DM. Keywords:American Diabetes Association, bariatric, diabetes, International Diabetes Federation, remission Ravindra S, Miras A. Moving goal posts: Definition of diabetes remission after bariatric surgery. J Obes Metab Res 2015;2:16-21 Ravindra S, Miras A. Moving goal posts: Definition of diabetes remission after bariatric surgery. J Obes Metab Res [serial online] 2015 [cited2018 May 3];2:16-21. Available from: The Problem of Obesity and Type 2 Diabetes Mellitus The global prevalence of type 2 diabetes mellitus (T2DM), a Continue reading >>

Diabetes 'cure': Diet & Exercise Work For Some

Diabetes 'cure': Diet & Exercise Work For Some

People with Type 2 diabetes can reverse their condition with diet and exercise, although remission is not very common, according to a new study from the Centers for Disease Control and Prevention. After one year of regular counseling sessions to encourage weight loss and physical activity, 11.5 percent of obese adults with Type 2 diabetes saw their condition at least partially reverse — meaning their blood sugar levels decreased to those of a prediabetic, without the need for medication. Just 2 percent of those who did not receive intensive counseling partially reversed their diabetes. After four years, the rate of partial diabetes remission in the counseling group declined slightly, to 7 percent. Full remission — achieving normal blood sugar levels — was rarer, with just 1.3 percent of people in the counseling group and 0.1 percent in the non-counseling group meeting this goal after one year. Type 2 diabetes has traditionally been seen as a progressive disease that is managed rather than cured. Recent studies have suggested it can be reversed with weight loss surgery, or by following an extreme diet that mimics surgery. However, until this study, little was known about the rate of long-term diabetes reversal without surgery or extreme dieting. About 26 million Americans have diabetes, according to the Centers for Disease Control and Prevention. The study confirms that complete Type 2 diabetes remission is rare, but that partial remission is an obtainable goal for some patients, the researchers said. Experts said that, because the definitions of complete or partial diabetes remission are arbitrary, researchers should not focus on these measures. What's more important is that patients improve their weight and blood sugar levels, as people in this study did, said Dr Continue reading >>

Which Criteria Should Be Used To Define Type 2 Diabetes Remission After Bariatric Surgery?

Which Criteria Should Be Used To Define Type 2 Diabetes Remission After Bariatric Surgery?

Which criteria should be used to define type 2 diabetes remission after bariatric surgery? Ramos-Levi et al.; licensee BioMed Central Ltd.2013 Comparison of diabetes remission rates after bariatric surgery using two different models of criteria. Retrospective analysis of data from 110 patients with type 2 diabetes and morbid obesity who underwent bariatric surgery, preoperatively and at 18-month follow-up. Comparison of two models of remission: 1) 2009 consensus statement criteria; 2) simple criteria using ADAs HbA1c diabetes diagnostic cut-off values. Patients mean SD preoperative characteristics were: age 53.3 9.5 years, BMI 43.6 5.5 kg/m2, HbA1c 7.9 1.8%, duration of diabetes 7.6 7.5 years. 44.5% of patients with previous insulin therapy. With 2009 consensus statement criteria: complete, partial and no remission in 50%, 12.7% and 37.3%, respectively; with HbA1c criteria: 50%, 15% and 34.5% in the analogous categories (p = 0.673). We suggest a simpler approach to evaluate diabetes remission after bariatric surgery, following the rationale of the definition of diabetes itself. DiabetesDiabetes remissionBariatric surgeryRemission criteriaMorbid obesity Buse et al. [ 1 ] proposed in 2009 a consensus definition of diabetes remission. These clear, although strict, criteria prompt the need to reconsider diabetes remission rates after bariatric surgery. The objective of this study is to compare diabetes remission rates using Buses consensus group criteria with those obtained with a simpler definition based on the American Diabetes Associations (ADA) glycosylated hemoglobin (HbA1c) cut-off levels used to diagnose diabetes [ 2 ], after bariatric surgery. Data were retrospectively analyzed from a cohort of 539 patients who underwent bariatric surgery with a preoperative diagno Continue reading >>

A Predictive Model For Lack Of Partial Clinical Remission In New-onset Pediatric Type 1 Diabetes

A Predictive Model For Lack Of Partial Clinical Remission In New-onset Pediatric Type 1 Diabetes

A predictive model for lack of partial clinical remission in new-onset pediatric type 1 diabetes Katherine R. Marino , Rachel L. Lundberg , Aastha Jasrotia , Louise S. Maranda , Michael J. Thompson , Bruce A. Barton , Laura C. Alonso , Benjamin Udoka Nwosu Affiliation: Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Diabetes Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Diabetes Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America * E-mail: [email protected] Affiliation: Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America >50% of patients with new-onset type 1 diabetes (T1D) do not enter partial clinical remission (PCR); early identification of these patients may improve initial glycemic control and reduce long-term complications. To determine whether routinely obtai Continue reading >>

Re: Beating Type 2 Diabetes Into Remission: A Consensus-based Working Definition

Re: Beating Type 2 Diabetes Into Remission: A Consensus-based Working Definition

Re: Beating type 2 diabetes into remission: a consensus-based working definition BMJ 2017; 358 doi: (Published 13 September 2017) Cite this as: BMJ 2017;358:j4030 Re: Beating type 2 diabetes into remission: a consensus-based working definition As Louise McCombie and colleagues state in their paper, there is little doubt that, from a pathophysiological perspective, remission of type 2 diabetes is probably achievable for many patients. Apparently, this is not supported by current medical records, which suggest that remission is almost non-existent. Many colleagues will argue that this is reality in practice, since sustainable remission, sometimes referred to as reversal, is hampered by a diversity of motivational and environmental factors. However, McCombie et al. raise another important point, highlighting the lack of consensus regarding criteria to define type 2 diabetes remission. Availability of such consensus will not only facilitate the socio-economic debate on lifestyle as therapeutic option, but may also be of practical value in monitoring and stimulating individual efforts to change unhealthy behavior. Hyperglycemia, dyslipidemia and hypertension are caused by systemic low-grade inflammation, ectopic fat deposition and (compensatory) hyperinsulinemia, brought about by a variety of lifestyle features. Clearly, lifestyle intervention doesnt bring permanent remission overnight, and complete remission may not be accomplishable in all patients. In line with existing consensus viewpoints, the authors make a case to use HBA1c and glucose values to define criteria for remission. However, as active implementers of a therapeutic lifestyle program for type 2 diabetic patients, which is currently attracting considerable attention in the Netherlands ( ), we would like to sug Continue reading >>

Ada Criteria Better Defines T2d Remission After Surgery

Ada Criteria Better Defines T2d Remission After Surgery

ADA criteria better defines T2D remission after surgery No significant differences found between the criteria Call for scientific societies to uniform inclusion criteria of complete or partial remission of T2D Owen Haskins - Editor in chief, Bariatric News According to Spanish researchers, the criteria of the American Diabetes Association (ADA) should be utilised to evaluate diabetes remission after bariatric surgery. The paper, published online by on Biomed Central states the ADA criteria may be of a more practical and affordable clinical application, as well as realistic regarding what outcomes to expect. The researchers from Complutense University, Madrid, Spain, undertook a retrospective analysis of patients with type 2 diabetes and morbid obesity, who underwent bariatric surgery. They then compared the two following models of remission of type 2 diabetes after bariatric surgery: 2009 consensus statement (model 1): complete remission if normal measures of glucose metabolism were achieved (HbA1c < 6% and FG < 100 mg/dl [< 5.6mmol/l]; partial remission if HbA1c < 6.5% and FG 100125 mg/dl (5.6-6.9mmol/l), in both cases in the absence of pharmacologic therapy or on-going procedures, for a duration of at least one year. HbA1c criteria, based on HbA1c levels used to define diabetes in current ADA guidelines (model 2): remission if HbA1c < 5.7%, improvement if HbA1c 5.7 - 6.5%, in both cases without hypoglycemic treatment and a duration of at least one year, and no remission if these criteria were not met. The researchers collect data from 539 patients who underwent bariatric surgery with a preoperative diagnosis of diabetes and morbid obesity, and recorded the duration of diabetes, previous hypoglycaemic treatment, age, weight, height, BMI, fasting glucose (FG) and HbA1c Continue reading >>

Type 2 Diabetes: Can You Cure It? - Topic Overview

Type 2 Diabetes: Can You Cure It? - Topic Overview

Can you "reverse" type 2 diabetes? Can you cure it? Diabetes can go into remission. When diabetes is in remission, you have no signs or symptoms of it. But your risk of relapse is higher than normal.1 That's why you make the same daily healthy choices that you do for active type 2 diabetes. There is no known cure for type 2 diabetes. But it can be controlled. And in some cases, it goes into remission. For some people, a diabetes-healthy lifestyle is enough to control their blood sugar levels. That means losing weight if you are overweight, eating healthy foods, and being more active. But most people with type 2 diabetes also need to take one or more medicines or insulin. Of those people who don't need diabetes medicine, some find that their diabetes does "reverse" with weight control, diabetes-healthy eating, and exercise. Their bodies are still able to make and use insulin, and their blood sugar levels go back to normal. Their diabetes is in remission. "Complete remission" is 1 year or more of normal A1c and fasting glucose levels without using diabetes medicine. When you have complete remission, you still get tested for high blood sugar, high blood pressure, high cholesterol, and kidney and eye problems. You do regular foot checks.1 "Prolonged remission" is 5 years or more of normal A1c and blood sugar levels without using diabetes medicine. You might have lab tests less often. But your doctor will still check on any heart, eye, foot, or other health problems you have had from diabetes, even if they are better than before.1 Remission is most likely in the early stage of diabetes or after a big weight loss. It can also happen after bariatric surgery for weight loss, which can trigger healthy changes in the body's insulin system. Remission is less likely in the later st Continue reading >>

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