The . Jans A, Nslund I, Ottosson J, Szabo E, Nslund E, Stenberg E. PLoS Med. Scottish Intercollegiate Guidelines Network;SIMD, The study has a number of limitations. Multivariable analyses using complete case analyses showed similar results to the analyses using imputed data (S5 and S6 Tables, S4 and S5 Figs). For secondary analyses, adjusted mean ambulatory systolic blood pressure was 3.06 mmHg lower (95% CI 0.565.56 mmHg. Prevalence of remission of type 2 diabetes among people with type 2 diabetes in Scotland who had at least 1 HbA1c 48 mmol/mol (6.5%) after diagnosis of diabetes and had at least 1 HbA1c recorded in 2019 stratified by age group and change in weight from diagnosis to 2019. 8600 Rockville Pike Edinburgh actively contributes to the study programme of the Scottish Diabetes Research Network (SDRN). A number of clinical diabetes and endocrinology studies are being conducted by the centre's NHS consultants, including contributions to multi-centre trials and audits. This could reduce the burden of chronic disease for both patients and health services. ORs for remission of type 2 diabetes (95% CI) in Scotland 2019 derived, MeSH We identified previous bariatric surgery from NHS Scotland hospital admission data by identifying people with codes for relevant gastrointestinal surgery (based on the combination of Office of Population Censuses and Surveys Classification of Interventions and Procedures version 4 (OPCS-4) codes and the International Classification of Diseases-10th revision (ICD-10) diagnostic code for obesity used by Public Health Scotland) (see S2 Table for diagnosis and procedure codes). Sensitivity analysis with 10,846 people with comorbidities removed. Office of Population Censuses and Surveys Classification of Interventions and Procedures version 4;OR, To date biosamples have been used for DNA extraction and genome-wide genotyping. and transmitted securely. Patterns of Glucose and Diabetes Management among Scottish Diabetes Research Network Type 1 Diabetes Bioresource participants. Institute of Cardiovascular and Medical Sciences, The University of Glasgow, Glasgow, United Kingdom. Our cohort consisted of 162,316 individuals, all of whom had at least 1 HbA1c 48 mmol/mol (6.5%) at or after diagnosis of diabetes and at least 1 HbA1c recorded in 2019 (78.5% of the eligible population). The research register is one of the reasons why Scotland is at the forefront of research into diabetes. doi: 10.2337/diacare.27.5.1047 . Stephanie.Read@ed.ac.uk. SC005336, VAT Registration Number GB592950700, and is acknowledged by the UK authorities People in the least deprived quintiles were more likely to achieve remission than people in the most deprived quintile in univariable analysis, but these differences were not statistically significant in multivariable analyses (S5 Table). Here you'll find information about campaigns and projects we're running to raise awareness, improve care and provide help, support and information for people with diabetes and their families across Scotland. Our study additionally found that weight loss was strongly associated with remission, which was not examined by Karter and colleagues. PURPOSE: The Scottish Diabetes Research Network (SDRN)-diabetes research platform was established to combine disparate electronic health record data into research-ready linked datasets for diabetes research in Scotland. Additionally, evaluating the impact of new clinical pathways to support remission of type 2 diabetes requires understanding of patterns of remission prior to introduction of new services. Passionate about what we do, we put lived experience of diabetes at the heart of everything we do. Other potential options include use of estimated HbA1c; however, this is not established in routine clinical settings [7,30]. We estimated prevalence under 3 sets of assumptions finding a range of 3.7% to 9.9%, although we believe the most appropriate estimate is of 4.8% from our primary analysis. Estimating prevalence of type 2 diabetes remission is needed to inform allocation of resources and creation of new clinical pathways to support this group of people to stay in remission. We calculated how many people were in remission of type 2 diabetes in 2019 in Scotland from a national type 2 diabetes register. This challenged the perception of type 2 diabetes as a chronic progressive disease. Page saved! scheme. The prevalence estimates are influenced by our definition of type 2 diabetes remission. Mireille Captieux, Diabetes research (Edinburgh, Scotland) | Read 823 articles with impact on ResearchGate, the professional network for scientists. By 2045, it is estimated that there will be 700 million people in the world with diabetes. -. We carried out a cross-sectional study estimating the prevalence of remission of type 2 diabetes in all adults in Scotland aged 30 years diagnosed with type 2 diabetes and alive on December 31, 2019. We extracted data for people with a diagnosis of type 2 diabetes who were registered as alive and resident in any Scottish health board on December 31, 2019. 0007). Polymorphisms in ST3GAL4, ST6GAL1, PHIP, FUT8 are associated with variation within the serum N-glycome of Scottish type 1 diabetes patients. We used a period of 1 year rather than 6 months to define remission as HbA1c tends to be measured on an annual basis in Scotland, particularly among people whose diabetes is well controlled. However, in routine clinical practice where diabetes reviews are approximately annual, it takes longer for people with short duration of diabetes to obtain all the necessary readings to meet criteria for prevalent remission. We found that the prevalence of type 2 diabetes remission in the study population was 4.8% in our primary analysis. Dr Robert Lindsay We excluded the small number of people aged <30 years at diagnosis of type 2 diabetes to mitigate against the inadvertent inclusion of people with type 1 diabetes. SC005336, VAT Registration Number GB592950700, and is acknowledged by the UK authorities as a Oct 2016 DOI: 10.1093/ije/dyw152, McKeigue PM, Spiliopoulou A, McGurnaghan S, Colombo M, McDonald TJ, Colhoun HM, on behalf of the SDRNT1BIO investigators. Age and sex were included a priori in the models. 29 June, 2023 14:43. Similarities between our findings and Karter and colleagues were that remission of type 2 diabetes was more common in people aged 65 years, people who were not prescribed GLT at diagnosis of diabetes, and people who had a lower HbA1c at diagnosis. SCI-Diabetes contains demographic and clinical data for over 99.5% of people with a diagnosis of diabetes in Scotland [18]. A 70% increase in prevalent cases of T1DM in those aged under 15 years in Europe between 2005 and 2020 is predicted. not missing at random;OPCS-4, Key differences in characteristics of people in remission in 2019 compared to people who were not in remission in 2019 were older age (70% of people in remission were aged 65, compared to 54% of people not in remission); greater weight loss between diagnosis of diabetes and 2019; lower proportions with previous prescriptions of GLT (25% of people in remission had been prescribed GLT compared to 84% of people not in remission); lower mean HbA1c at diagnosis (note that although all people in our cohort had at least 1 HbA1c 48 mmol/mol from diagnosis to 2019, 38% of people in remission had an HbA1c <48 mmol/mol at diagnosis); and higher prevalence of previous history of bariatric surgery (although overall numbers of people with a history of bariatric surgery were small) (see Table 1). Primary Care Diabetes Society;SCI-Diabetes, Find out more about the Diabetes Scotland team. The mean (SD) HbA1c at follow-up was 63.0 (15.5) mmol/mol in the intervention group and 67.8 (14.7) mmol/mol in the usual care group. Since 2014 he has been a visiting researcher at Edinburgh University Centre for Population Health Sciences working with Professor Sarah Wild. A 1-year period was the most commonly used duration in definitions of remission (30% of definitions published in the research literature since 2009) [8]. Edinburgh actively contributes to the study programme of the Scottish Diabetes Research Network (SDRN). We defined remission as all HbA1c values <48 mmol/mol in the absence of glucose-lowering therapy (GLT) for a continuous duration of 365 days before the date of the last recorded HbA1c in 2019. Discover more about this growing movement campaigning for fair and equal access to diabetes technology. Methods Repeated annual cross-sectional studies of type 1 diabetes incidence were conducted. In multivariable models, factors associated with remission were age 65 years, HbA1c <48 mmol/mol (6.5%) at diagnosis, no history of GLT prescription, any weight loss from diagnosis to 2019, and a previous history of bariatric surgery. Disclaimer. Supported Telemonitoring and Glycemic Control in People with Type 2 Diabetes: The Telescot Diabetes Pragmatic Multicenter Randomized Controlled Trial (PLOS Medicine,2016), Qualitative study of telemonitoring of blood glucose and blood pressure in type 2 diabetes (BMJ Open, 2015). Second, inclusion of the 9,219 patients who had never had an HbA1c 48 mmol/mol in both numerator and denominators meant that estimated prevalence of diabetes remission in the 171,535 patients with at least 1 HbA1c in 2019 was 9.9% (95% CI 9.7 to 10.0). Such ambiguities reflect the problems of defining a disease and its remission based on cutoffs in 2 continuous distributions (FPG and HbA1c). Recommendations for Managing Type 2 Diabetes in Primary Care 2017 [26.08.2020]. It is possible that older people were diagnosed with diabetes with HbA1c values closer to diagnostic thresholds or after minor weight gain, and, therefore, only minor decreases in HbA1c or minor weight loss might be more likely to result in remission than among younger people. Estimating the prevalence of remission of type 2 diabetes in Scotland in 2019 creates a baseline to evaluate the impact of future initiatives to support remission and for future studies of duration of remission and effect on risk of complications of diabetes. granted degree awarding powers. Multiple Imputation by Chained Equations;NHS, The availability of the home monitoring results may give professionals more confidence in their assessment of the effectiveness of the patients self-care and medication and lead to effective regimens being established more quickly. PLOS Medicine publishes research and commentary of general interest with clear implications for patient care, public policy or clinical research agendas. Although there are national and organisational consensus definitions, as yet there is no international consensus for defining remission, resulting in considerable heterogeneity in remission definitions used in research [8]. N = 152,934. General endocrine clinics are provided at the Royal Infirmary of Edinburgh, Western General Hospital and St Johns Hospital . Diabetic Medicine RESEARCH ARTICLE Open Access Type 1 diabetes incidence in Scotland between 2006 and 2019 India Thomson, Niall Anderson, Louise Bath, Sarah Kiff, Chris Patterson, Sam Philip, Norman Waugh, Sarah H. Wild See all authors First published: 14 February 2023 https://doi.org/10.1111/dme.15069 Read the full text PDF Tools Share Abstract doi:10.1371/journal.pmed.1003828, Academic Editor: Ronald C. W. Ma, Chinese University of Hong Kong, CHINA, Received: June 8, 2021; Accepted: September 30, 2021; Published: November 2, 2021. First, assuming that none of the 35,321 patients without an HbA1c reading in 2019 was in remission and adding them to the denominator resulted in an estimated prevalence in the whole cohort of 206,856 of 3.7% (95% CI 3.6 to 3.8). In addition to touring the University of Edinburgh research facilities at the Western General Campus, the group also learned about the vital . Prevalence of remission was estimated to be 3.7% if none of the 17% of people with missing HbA1c data for 2019 was in remission. doi: 10.15277/bjd.2019.221 Particularly, the effect of different durations of sustained remission and complications. Clipboard, Search History, and several other advanced features are temporarily unavailable. Diabetes Research (edinburgh, Scotland), Volume 27 . Karter and colleagues also found shorter duration of diabetes to be associated with incidence of remission in their cohort study because incidence studies are better suited to identifying the effect of shorter duration on remission than cross-sectional studies. Scottish Care Information-Diabetes;SGLT-2, We described the characteristics of people who were in remission of type 2 diabetes compared to people who were not in remission and created a mathematical model that shows the probability of achieving remission in 2019 based on these characteristics. N = 152 934 (multiple imputation) and N = 110,814 (CCA). Compared to people who did not achieve remission, people in remission of type 2 diabetes tended to be older; have a lower HbA1c at diagnosis; have never taken any glucose-lowering medication; have lost weight since the diagnosis of diabetes; and have had bariatric surgery. There's a lot of ways to get involved with us. These people should be recognised and coded appropriately so they can be supported by their clinicians. Within HbA1c categories, people with HbA1c <48 mmol/mol (<6.5%) at diagnosis had the highest odds of remission in 2019 compared to people with HbA1c 48 to 52 mmol/mol (6.5% to 6.9%) at diagnosis (Fig 3). Poster presentation at the 53, Colombo M, Valo E, McGurnaghan S, Blackbourn L, Dalton RN, Dunger D, Groop PH, McKeigue PM, Forsblom C, Colhoun HM, on behalf of the SDRNT1BIO and Finndiane Investigators. Factors associated with remission were older age (odds ratio [OR] 1.48 [95% CI 1.34 to 1.62] P < 0.001) for people aged 75 years compared to 45 to 54 year group), HbA1c <48 mmol/mol at diagnosis (OR 1.31 [95% CI 1.24 to 1.39] P < 0.001) compared to 48 to 52 mmol/mol), no previous history of GLT (OR 14.6 [95% CI 13.7 to 15.5] P < 0.001), weight loss from diagnosis to 2019 (OR 4.45 [95% CI 3.89 to 5.10] P < 0.001) for 15 kg of weight loss compared to 0 to 4.9 kg weight gain), and previous bariatric surgery (OR 11.9 [95% CI 9.41 to 15.1] P < 0.001). granted degree awarding powers. ICD-10 and ICD-9 codes used to identify comorbidities. Brian Kennon, Intention-to-treat analyses were performed. S4 Table. Available from: Read SH, Kerssens JJ, McAllister DA, Colhoun HM, Fischbacher CM, Lindsay RS, et al.. Trends in type 2 diabetes incidence and mortality in Scotland between 2004 and 2013. Bariatric surgery history and weight loss were each independently associated with remission. We used a cross-sectional whole population study design to estimate the prevalence of remission of type 2 diabetes in Scotland in 2019 and describe the characteristics of people in remission and people not in remission. Prevalence of remission of type 2 diabetes among people with type 2 diabetes, Fig 3. Further research is needed to investigate the association between remission and complications of diabetes including mortality. A company limited by guarantee registered in England and Wales with (no.00339181) and registered office at Wells Lawrence House, 126 Back Church Lane London E1 1FH. SC005336, VAT Registration Number GB592950700, and is acknowledged by the UK authorities as a . Metabolic UnitWestern General HospitalCrewe Road SouthEdinburghEH4 2XE, Outpatients Department 2Royal Infirmary of EdinburghLittle France CrescentEdinburghEH16 4SA, Diabetes DepartmentSt John's HospitalHowden South RoadLivingstonEH54 6PP, Website funded by Diabetes Clinical Research Fund Edinburgh and Lothian Health Foundation, This site does not display on old versions of Internet Explorer - NHS Lothian users please use Firefox, Edinburgh Centre for Endocrinology & Diabetes, Information leaflets on medications for type 2 diabetes, WGH Managing type 1 diabetes during illness, SJH Managing type 1 diabetes during illness. In our data, remission definition had to be based on HbA1c alone, because FPG is rarely measured after diagnosis of diabetes in the UK. However, more data are needed to establish whether a very low calorie diet approach will be effective or appropriate in people that have been excluded from trials. In secondary analysis, there was a greater number of telephone calls between practice nurses and patients in the intervention compared with control group (rate ratio 7.50 (95% CI 4.4512.65,p< 0.0001) but no other significant differences between groups in use of health services were identified between groups. -, Nagi D, Hambling C, Taylor R. Remission of type 2 diabetes: a position statement from the Association of British Clinical Diabetologists (ABCD) and the Primary Care Diabetes Society (PCDS). However, the Diabetes UK (DUK)James Lind Alliance Priority Setting Partnership has recently identified remission of type 2 diabetes as the top shared priority among people living with diabetes and their carers and healthcare professionals [13], and the findings of the work are being shared with patient groups, Diabetes Scotland, and DUK. Median weight decreased between diagnosis of type 2 diabetes and 2019 across the whole population, with people who were in remission in 2019 losing a median 6.5 kg of weight compared to 3.3 kg among people not in remission. Passionate about what we do, we put lived experience of diabetes at the heart of everything we do. It was established during 2010-13 and involved 6,127 participants, aged 16 years and older, from across 12 Scottish NHS Health Boards. Journal: Diabetes Research (edinburgh, Scotland) Cited by 1. The Queen spoke with Professor Lucy Walker, right, during her visit (Justin Tallis/PA) The Queen donned a white lab coat to learn about pioneering new research into type 1 . Methods A cohort of 1849411 individuals aged <35 years without diabetes, including all those in Scotland who subsequently tested positive for SARS-CoV-2, was followed from 1 March 2020 to 22 November 2021. Glycaemia Trajectories in Type 1 Diabetes and their Association with Complications (Diabetes UK funded), Harnessing genetic information in the SDRNT1BIO to understand Type 1 diabetes and its complications (Diabetes UK funded), Extreme Phenotypes Relevant to Diabetic Complications in Type 1 Diabetes (JDRF funded), Validation of Novel and Candidate Biomarkers for Diabetic Kidney Disease in Large Cohorts of people with Type 1 Diabetes (JDRF funded), Predictors of Early Stage Decline in Kidney Function in Type 1 Diabetes (JDRF funded), National Institute of Bioprocessing Research and Training (NIBRT), Dublin Ireland, Immunoassay Biomarker Core Laboratory, Dundee UK, Wellcome Trust Clinical Research Facility, Edinburgh UK, Exeter Clinical Laboratory, Royal Devon and Exeter Hospital, Exeter UK, Well Child Laboratory, Kings College London UK, Interested collaborators should contact the Study Coordinator in the first instance, email, Bermingham ML, Colombo M, McGurnaghan S, Blackbourn LAK, Vukovi FM Pui Bakovi, Trbojevi-Akmai I, Lauc G, Agakov F, Agakova AS, Hayward C, Klari L, Palmer CNA, Petrie JR, Chalmers J, Collier A, Green F, Lindsay RS, Macrury S, McKnight JA, Patrick AW, Thekkepat S, Gornik O, McKeigue PM and Colhoun HM, on behalf of the SDRN Type 1 Bioresource Investigators. Unless explicitly stated otherwise, all material is copyright The University of Edinburgh 2023. International Diabetes Federation. This unified centre facilitates service development, quality improvement, training and education in endocrinology and diabetes in Edinburgh and the Lothians. We identified diagnostic codes for severe comorbidity that could cause weight loss including previous diagnosis of dementia, end-stage kidney disease, liver cirrhosis, metastatic cancer, and cancer (excluding nonmelanoma skin cancer) with a 5-year look-back period applied to both metastatic cancer and cancer diagnoses (see S3 Table). 2017 Feb 27;2(2):CD009966. Available from. Unadjusted and adjusted odds for remission of type 2 diabetes from logistic regression model using complete case and multiple imputation datasets. STROBE, STROBE, Strengthening The Reporting of OBservational Studies in Epidemiology. Examples of recent key findings include analysis of the incidence and relative risks for COVID-19 infection, drug safety of insulin glargine and SGLT2 inhibitors, life expectancy estimates, evaluation of the impact of flash monitors on glycaemic control and diabetic ketoacidosis and time trend analysis showing that diabetic ketoacidosis (DKA) re. (NRS), through Diabetes Network. This was an exploratory cross-sectional analysis for which there was no . Unless explicitly stated otherwise, all material is copyright The University of Edinburgh 2023. (2021) Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study. This was an exploratory cross-sectional analysis for which there was no prespecified protocol. -, Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Glucose-lowering agents for treating pre-existing and new-onset diabetes in kidney transplant recipients. 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