Diabetes Metab J.  2022 Mar;46(2):165-180. 10.4093/dmj.2021.0377.

Not Control but Conquest: Strategies for the Remission of Type 2 Diabetes Mellitus

• Kim J
• Kwon HS

• KMID: 2527713
• DOI: http://doi.org/10.4093/dmj.2021.0377

Abstract

A durable normoglycemic state was observed in several studies that treated type 2 diabetes mellitus (T2DM) patients through metabolic surgery, intensive therapeutic intervention, or significant lifestyle modification, and it was confirmed that the functional β-cell mass was also restored to a normal level. Therefore, expert consensus introduced the concept of remission as a common term to express this phenomenon in 2009. Throughout this article, we introduce the recently updated consensus statement on the remission of T2DM in 2021 and share our perspective on the remission of diabetes. There is a need for more research on remission in Korea as well as in Western countries. Remission appears to be prompted by proactive treatment for hyperglycemia and significant weight loss prior to irreversible β-cell changes. T2DM is not a diagnosis for vulnerable individuals to helplessly accept. We attempt to explain how remission of T2DM can be achieved through a personalized approach. It may be necessary to change the concept of T2DM towards that of an urgent condition that requires rapid intervention rather than a chronic, progressive disease. We must grasp this paradigm shift in our understanding of T2DM for the benefit of our patients as endocrine experts.

Keyword

Consensus; Diabetes mellitus, type 2; Recovery of function

Figure

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  Fig. 1. Modeled probabilities for diabetes remission according to weight loss in patients who underwent laparoscopic adjustable gastric banding (red lines), and Roux-en-Y gastric bypass (blue lines). Adjusted relative risk (aRR) estimates and 95% confidence intervals were adjusted for percent weight change and a propensity score based on baseline demographic and clinical variables associated with the type of surgery. Adapted from Purnell et al. [28], with permission from Oxford University Press.

• 

  Fig. 2. Effect of intensive insulin therapy for 2 weeks at initial rapid correction of hyperglycemia on diabetic remission at 1 year after the intervention in patients with newly diagnosed type 2 diabetes mellitus. Adapted from Weng et al. [52], with permission from Elsevier. CSII, continuous subcutaneous insulin infusion; MDI, multiple daily insulin injection; OHA, oral hypoglycemic agent.

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  Fig. 3. Average weight change of participants completing at least a 1-year intervention, consisting of a review of 80 studies. Adapted from Franz et al. [72], with permission from Elsevier.

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  Fig. 4. Proportion achieving remission at 12 months according to weight loss via a very-low-calorie diet for 3 to 5 months. Adapted from Lean et al. [78], with permission from Elsevier. CI, confidence interval.

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  Fig. 5. Summary of strategies for type 2 diabetes mellitus remission. HbA1c, glycosylated hemoglobin; SGLT2i, sodium-glucose cotransporter-2 inhibitor; GLP1-RA, glucagon-like peptide-1 receptor agonist. Adapted from Taylor et al. [114], with permission from Portland Press.

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