Analysis

Beating type 2 diabetes into remission

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j4030 (Published 13 September 2017) Cite this as: BMJ 2017;358:j4030
  1. Louise McCombie, researcher1,
  2. Wilma Leslie, researcher1,
  3. Roy Taylor, professor2,
  4. Brian Kennon3,
  5. Naveed Sattar, professor4 ,
  6. Mike E J Lean, professor1
  1. 1Human Nutrition Section, School of Medicine, University of Glasgow, Glasgow, G31 2ER, UK
  2. 2Magnetic Resonance Centre, Campus for Ageing and Vitality, University of Newcastle, Newcastle Upon Tyne, UK
  3. 3Diabetes Centre, Queen Elizabeth University Hospital, Glasgow
  4. 4University of Glasgow Biomedical Research Centre, Glasgow
  1. Correspondence to: L McCombie louise.mccombie{at}glasgow.ac.uk

Recognising and accurately coding reversal of type 2 diabetes is key to improving outcomes and reducing healthcare costs, argue Louise McCombie and colleagues

Type 2 diabetes, generally perceived as progressive and incurable, now affects 5-10% of the population, about 3.2 million people in the UK.1 Until complications develop, most patients are managed entirely within primary care, with diabetes comprising a major part of general practice activity. About 10% of total UK NHS expenditure goes on treating diabetes, and international figures suggest that medical costs for people with diabetes are twofold to threefold greater than the average for age and sex matched people without diabetes.1

Application of current clinical guidelines to reduce glycated haemoglobin (HbA1c) levels and cardiovascular risks, primarily with drugs and generic lifestyle advice, has improved clinical outcomes, but many patients still develop vascular complications, and life expectancy remains up to six years shorter than in people without diabetes.2 The diagnosis carries important social and financial penalties for individuals, as well as poor health prospects.

Remission of diabetes (no longer having diabetes, at least for a period) is clearly attainable for some, possibly many, patients but is currently very rarely achieved or recorded. Greater awareness, documentation, and surveillance of remissions should improve health outcomes and reduce healthcare costs.

Changing management

In keeping with trends in most medical specialties, diabetes management is beginning to focus on reversible underlying disease mechanisms rather than treating symptoms and subsequent multisystem pathological consequences.34 Both (epi)genetic predisposition and ageing have a role in type 2 diabetes, but it is rare without weight gain.

Lowering blood glucose or HbA1c concentrations remains the primary aim of management, as reflected in current clinical guidelines and the actions of licensed drugs. However, management and guidelines focus on use of antidiabetes drugs, with only lip …

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