While it is often said that "Once you become diabetic, there is no cure" and "Once you start taking diabetic medication, you must keep taking it for life," a new study has revealed that one in 100 Japanese patients with type 2 diabetes can be cured.
These findings were presented by a research group led by Specially Appointed Associate Professor Kazuya Fujihara and Professor Hirohito Sone of the Department of Hematology, Endocrinology and Metabolism, Niigata University Graduate School of Medical and Dental Sciences, based on an analysis of the clinical data from the Japan Diabetes Clinical Data Management Study Group (JDDM) conducted on 48000 patients with type 2 diabetes who visited diabetes specialist clinics in Japan. The group also demonstrated that patients with a shorter duration since the diabetes diagnosis, lower glycated hemoglobin (HbA1c) level, higher body mass index (BMI), greater BMI reduction at 1 year, and no medication were more likely to achieve remission when compared to other diabetic patients. The study results have been published in Diabetes, Obesity and Metabolism.
The study included 48320 patients aged ≥18 years with type 2 diabetes who regularly visited diabetes specialist clinics across Japan and underwent routine measurements of HbA1c levels (an index for blood glucose levels) and were not in remission. They were followed from 1989 to 2022 to assess whether they achieved remission (HbA1c <6.5% for more than 3 months after stopping medication use). Additionally, the maintenance of remission for >1 year was evaluated, and factors associated with remission and relapse after achieving remission were examined.
During a median follow-up period of 5.3 years, 3677 patients achieved remission, resulting in an incidence rate of 10.5 per 1000 person-years (approximately 1%). A detailed analysis of patients' baseline characteristics demonstrated that a higher proportion of patients achieved remission if they were 1) male, 2) <40 years of age, 3) within 1 year after diabetes diagnosis, 4) had HbA1c <7.0%, 5) had a high BMI, 6) achieved >5% weight reduction at 1 year, and 7) did not receive medication. The incidence rates per 1000 person-years were 21.7, 27.8, 25, and 48.2 among patients who did not receive medication, had HbA1c <7.0%, achieved 5-9.9%, or ≥10% BMI reduction in 1 year, respectively.
In an analysis of weight change within 1 year, the incidence of remission in patients who achieved a 5.0-9.9% or >10% BMI reduction was 2.2 or 4.7 times higher, respectively, than that in patients with a 0-4.9% BMI reduction. In contrast, patients who gained weight were unlikely to achieve remission.
Among 3677 patients who achieved remission, only 1187 were able to maintain their remission for 1 year, while 2490 of them (approximately two-thirds of patients) experienced relapse (return of high blood glucose levels). Further analysis of the characteristics of the patients who experienced a relapse during the follow-up period demonstrated that patients with longer duration of diabetes diagnosis or lower BMI, as well as those who gained weight, were more likely to experience a relapse than the patients who did not experience a relapse.
Since East Asian populations, including the Japanese, are believed to have lower insulin-secreting capacity than that of the Western population, patients with type 2 diabetes in those populations exhibit differences in the pathogenesis and impact of obesity. It had been previously believed that Japanese patients with diabetes exhibited a lower incidence of remission than Western patients, leading to the perception that "there is no cure for diabetes." The findings of this study provide new insights by revealing that the remission rate in Japanese patients with diabetes is approximately 1%, similar to that observed in Western patients.
Journal Information
Publication: Diabetes, Obesity and Metabolism (DOM)
Title: Incidence and predictors of remission and relapse of type 2 diabetes mellitus in Japan: Analysis of a nationwide patient registry (JDDM73)
DOI: 10.1111/dom.15100
This article has been translated by JST with permission from The Science News Ltd. (https://sci-news.co.jp/). Unauthorized reproduction of the article and photographs is prohibited.