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. Findings: 0.3% (n=845) of those with diabetes had developed severe or fatal COVID-19, representing rate ratios of 3.86 (2.74, 5.45) in type 1 and 1.69 (1.56, 1.84) in type 2 diabetes. The Look AHEAD trial was stopped after 8 to 11 years of follow-up as the intensive lifestyle intervention did not decrease risk of CV events; however, the effect of remission of diabetes in this population was not described [10]. Martin Sudweeks. 160 people were randomized to the intervention group and 161 to the usual care group between June 6, 2011, and July 19, 2013. 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. General endocrine clinics are provided at the Royal Infirmary of Edinburgh, Western General Hospital and St Johns Hospital . This is an area-based deprivation measure that is the national standard for assessing socioeconomic status in research in Scotland [21] (categorised into SIMD quintiles where group 1 is the most deprived and group 5 the least deprived fifth of the population). The highest remission prevalence was in the >75-year age group both before and after stratifying by sex (as described in S1 Fig) and HbA1c at diagnosis (as described in S2 Fig). CCA, Complete case analysis. We calculated how many people were in remission of type 2 diabetes in 2019 in Scotland from a national type 2 diabetes register. Unadjusted and adjusted odds for remission of type 2 diabetes from logistic regression model using complete case and multiple imputation datasets 1 N = 162,316 (multiple imputation) and N = 117,048 (CCA). This was an exploratory cross-sectional analysis for which there was no . Scottish Diabetes Research Network. Over half (56%) of our cohort was aged 65 years or over in 2019, and 64% had had type 2 diabetes for at least 6 years. 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. Scottish Study Group for the Care of Diabetes in the Young and the Scottish Diabetes Research . The University of Edinburgh is a charitable body, registered in Scotland, with registration number Scotland has taken a 3 billion annual hit to its public revenues because of the UK's exit from the European Union, the Scottish government stated in a report published on Friday (23 June). Our findings highlight that there is no differentiation between intentional and nonintentional weight loss in current definitions of remission, and people who attain remission by unintentional weight loss caused by severe illness could still be defined as being in remission of type 2 diabetes [4,8]. Diabetologia. 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. There were few adverse events and these were equally distributed between the intervention and control groups. We managed missing data using multiple imputation using the Multiple Imputation by Chained Equations (MICE) method based on the assumption of the data being missing at random (MAR) [24]. Proportions of missing data in variables of interest were examined, and each covariable in our dataset was analysed using a univariable logistic regression model to estimate the odds of missing data within that variable and therefore explore likely mechanism of missingness. Sorry for the inconvenience. Two-way interactions between each of age, sex, HbA1c at diagnosis, GLT prescription, weight change, and bariatric surgery were investigated; however, none improved overall model fit and therefore were not included in the final model. This could reduce the burden of chronic disease for both patients and health services. Approval for creation of the linked dataset used in this analysis was obtained from the Scotland A multicentre research ethics committee, reference number 11/AL/0225. Stephanie.Read@ed.ac.uk. Coronavirus Disease 2019;DiRECT, Learn more about volunteering for us. ORs for remission of type 2 diabetes (95% CI) in Scotland 2019 derived from complete case analysis logistic regression model adjusted for all covariables listed on the plot. 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. We have previously shown that there were at least 96 unique definitions of diabetes remission used in the research literature from 2009 to 2020 [8]. Recognised body which has been Further research is needed to investigate the association between remission and complications of diabetes including mortality. ( 1) T1DM continues to be associated with substantial mortality, with an estimated current period life expectancy differential of 11-13 years. 2019 Nov 20;16(11):e1002985. The current research projects in 2017-18 are: 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 . Bookshelf eCollection 2022. For full functionality of this site, please enable JavaScript. The Scottish Diabetes Research Network (SDRN) was commissioned in 2006 by the Chief Scientist Office ( CSO) of the Scottish Government to improve the quality and increase the quantity of diabetes research in Scotland, as part of the UK Clinical Research Collaboration ( UKCRC ). Research using the SDRNT1BIO aims to identify those most at risk of diabetes complications and to investigate potential early-warning indicators of future complications. on behalf of the Scottish Diabetes Research Network Epidemiology Group, https://www.informationgovernance.scot.nhs.uk/pbpphsc/, https://www.cso.scot.nhs.uk/personal-awards-initiative/clinical-academic-fellowships/, https://www.diabetesatlas.org/upload/resources/material/20200302_133351_IDFATLAS9e-final-web.pdf, https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf, https://www.gov.scot/binaries/content/documents/govscot/publications/publication/2018/07/healthier-future-framework-prevention-early-detection-early-intervention-type-2/documents/healthier-future-framework-prevention-early-detection-early-intervention-type-2-diabetes/healthier-future-framework-prevention-early-detection-early-intervention-type-2-diabetes/govscot%3Adocument/healthier-future-framework-prevention-early-detection-early-intervention-type-2-diabetes.pdf, https://www.gov.scot/publications/scottish-index-multiple-deprivation-2016/, https://argoshare.is.ed.ac.uk/healthyr_book/, https://www.who.int/diabetes/publications/report-hba1c_2011.pdf?ua=1, Corrections, Expressions of Concern, and Retractions. Multiple Imputation by Chained Equations;NHS, Over half (56%) of our cohort was aged 65 years or over in 2019, and 64% had had type 2 diabetes for at least 6 years. eCollection 2019 Nov. Whittaker E, Read SH, Colhoun HM, Lindsay RS, McGurnaghan S, McKnight JA, Sattar N, Wild SH; Scottish Diabetes Research Network Epidemiology Group. Continuous covariates at diagnosis were defined as the median of all values recorded within a 90-day window around diagnosis (HbA1c at diagnosis; BMI at diagnosis; and weight at diagnosis). We defined GLT as any combination of metformin, sulphonylureas, thiazolidinediones, dipeptidyl peptidase 4 (DPP-4) inhibitors, sodium glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor (GLP-1) agonists, and insulin. Further research is required to investigate whether GLT has a causal relationship with failure to achieve remission. The site is secure. Using a 1-year duration of HbA1c below the diagnostic threshold for diabetes in the absence of GLT also facilitates comparison with previous studies on remission. ORs for remission of type 2 diabetes (95% CI) in Scotland 2019 derived from complete case analysis logistic regression model adjusted for all covariables listed on the plot. S3 Table. Recommendations for Managing Type 2 Diabetes in Primary Care 2017 [26.08.2020]. Passionate about what we do, we put lived experience of diabetes at the heart of everything we do. 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. Learn more about the past, present and future of diabetes research in Scotland. SES was derived from an area-based measure with Q5 and Q1 representing the most deprived and afuent quintiles, respectively. SC005336, VAT Registration Number GB592950700, and is acknowledged by the UK authorities as a Our study additionally found that weight loss was strongly associated with remission, which was not examined by Karter and colleagues. Limitations of the study include the use of a limited subset of possible definitions of remission of type 2 diabetes, missing data, and inability to identify self-funded bariatric surgery. Prevalence estimates also provide context for clinical decision-making, for example, identifying groups for whom remission is most likely to be achievable in order to target limited resources for intensive lifestyle management. The Diabetes Remission Clinical Trial (DiRECT) was the first trial to use a low calorie diet intervention to assess type 2 diabetes remission as a primary outcome. Such a definition would be difficult to implement in routine healthcare records. University homepage go back to the start and try again, Schools and departments list browse all areas of the University, Freedom of information publication scheme, There may be a typing mistake in the address bar. Strengthening The Reporting of OBservational Studies in Epidemiology;WHO, 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. International Diabetes Federation;MAR, The first sensitivity analysis assumed that none of the people without an HbA1c reading in 2019 were in remission. Intention-to-treat analyses were performed. Robert Lindsay, In conclusion, we have shown that approximately 5% of people with type 2 diabetes in Scotland in 2019 appear to be in remission and that history of never having GLT, weight loss since diagnosis, HbA1c <48 mmol/mol (6.0%) at diagnosis, age 65 years, and previous bariatric surgery are associated with remission. as a 1988 | Diabetes research (Edinburgh, Scotland) pmid:3046820 Assessment of early stage autonomic nerve dysfunction in diabetic subjects--application of power spectral analysis of heart rate variability Since the publication of these trials, achieving remission of type 2 diabetes has been identified as a top priority by people with diabetes and their carers [13]. Scottish Care Information-Diabetes;SGLT-2, 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 found that about 1 in 20 of people with type 2 diabetes in the study population were in remission of type 2 diabetes. SC039136). doi: 10.1371/journal.pmed.1002985. Two recent trials have additionally shown that it is also possible to achieve remission of type 2 diabetes through weight loss using very low calorie diets [10,11]. 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. Scottish Diabetes Research Network Type 1 Bioresource (SDRNT1BIO). Patterns of Glucose and Diabetes Management among Scottish Diabetes Research Network Type 1 Diabetes Bioresource participants. Fig 1 provides a description of the cohort selection for different aspects of the analysis. For secondary analyses, adjusted mean ambulatory systolic blood pressure was 3.06 mmHg lower (95% CI 0.565.56 mmHg,p= 0.017) and mean ambulatory diastolic blood pressure was 2.17 mmHg lower (95% CI 0.623.72,p= 0.006) among people in the intervention group when compared with usual care after adjustment for baseline differences and minimization strata. ORs for remission of type 2 diabetes (95% CI) in Scotland 2019 derived, MeSH Primary Care Diabetes Society;SCI-Diabetes, He presented his research at the European Diabetes Epidemiology Group meeting in Dublin in 2016 on 'The prevalence of retinopathy at diagnosis of Type 2 diabetes in Scotland 2007-2013'. (NRS), through Diabetes Network. Adjusted for all variables in the model (listed in first column of the table). 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. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. This definition will be difficult to implement in routine clinical care in many settings when date of starting a lifestyle intervention may not be recorded and resources for measuring HbA1c more frequently than annually are limited. Patients and the public were not involved in the design, conduct, or reporting of this research. not missing at random;OPCS-4, Both studies found no association between BMI at diagnosis of type 2 diabetes and remission. Unless explicitly stated otherwise, all material is copyright The University of Edinburgh 2023. copyright The University of Edinburgh. doi: 10.2337/diacare.27.5.1047 . 2-hr PG, 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. 2022 Jul 4;23(13):7435. doi: 10.3390/ijms23137435. 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. 2004;27(5):104753. International Diabetes Federation. Get our monthly round-up of all the latest diabetes news, what we're up to and our latest activities. Research using the SDRNT1BIO aims to identify those most at risk of diabetes complications, and to investigate potential early-warning indicators of possible future complications. Multivariable analyses using complete case analyses showed similar results to the analyses using imputed data (S5 and S6 Tables, S4 and S5 Figs). Our finding that remission is strongly independently associated with weight loss supports the results from the DiRECT trial where two-thirds of the 15% of trial participants that lost over 10 kg were in remission at 24 months [12]. 0007). Therefore, data were not missing completely at random (MCAR) and were either MAR or not missing at random (NMAR). Naveed Sattar, The major focus for endocrine research is within the British Heart Foundation Centre for Cardiovascular Science (Deputy Director - Professor Rebecca Reynolds): Centre for Cardiovascular Science website. granted degree awarding powers. Find out about about events in your area, and how you can help raise vital funds for Diabetes UK. Age in 2019 was calculated by subtracting date of birth from December 31, 2019, and continuous covariates in 2019 were defined as the median of values recorded in the 365 days before December 31, 2019. Odds of missing data in people with type 2 diabetes in Scotland diagnosed 30 years of age who had at least 1 HbA1c 48 mmol/mol (6.5%) after diagnosis of diabetes and who were alive and had at least 1 HbA1c recorded in 2019. A total of 7,710 people (4.8% [95% confidence interval [CI] 4.7 to 4.9]) were in remission of type 2 diabetes. Remission of type 2 diabetes was assessed between January 1, 2019 and December 31, 2019. Findings from trial settings have shown that remission is more likely in people with a short duration of diabetes. Edinburgh actively contributes to the study programme of the Scottish Diabetes Research Network (SDRN). The Scottish Diabetes Research Network epidemiology group database includes information from health records for people with a diagnosis of diabetes in Scotland. The DiaRem score (developed to predict probability of remission within 5 years after bariatric surgery) also showed that age, HbA1c level, and GLT use were preoperative predictors of remission [31]. Characteristics associated with type 2 diabetes remission in 2019 in the primary logistic regression analysis of the imputed dataset were age in 2019, HbA1c at diagnosis, weight change, history of GLT, and history of bariatric surgery. Genotypic Associations with C-peptide Persistence in People with Type 1 Diabetes. Available from. Another national initiative is the SHARE register which is open to everyone in Scotland (not just those with diabetes). N = 110,814. For example, people with dementia had high odds of missing data compared to people who did not have dementia (OR 3.02 [95% confidence interval [CI] 2.70 to 3.37] P < 0.001) (S4 Table). We concluded that supported telemonitoring resulted in clinically important improvements in control of glycaemia in patients with type 2 diabetes in family practice. Our cohort was predominantly of white ethnicity (74%), and ethnicity data were missing for 19% of the cohort. STROBE, STROBE, Strengthening The Reporting of OBservational Studies in Epidemiology. N-Glycan Profile and Kidney Disease in Type 1 Diabetes. You can give permission for any leftover blood samples, taken by your doctor, to be stored and used for future research. Our aims were to estimate the prevalence of remission of type 2 diabetes in Scotland in 2019 and to compare the characteristics of people with and without type 2 diabetes remission at the population level. Finally, we may have underestimated the proportion of people who had received bariatric surgery as we did not have access to data on procedures performed in private hospitals, but bariatric surgery is relatively uncommon in the UK. CI, confidence interval; OR, odds ratio. Our prevalence estimates suggest that a reasonably large proportion of people achieve remission of type 2 diabetes in routine clinical care outside trial or bariatric surgery settings. The SDRNT1BIO is a research collaboration involving researchers, clinicians and people with diabetes and managed by the SDRNT1BIO steering committee. Find out more about the Diabetes Scotland team. Remission of type 2 diabetes was assessed between January 1, 2019 and December 31, 2019. There's a lot of ways to get involved with us. Find out more about campaigns in Scotland and how you can get involved. Professionals had remote access at any time to self monitored blood glucose levels and average blood pressure. The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript. Diabetes research (Edinburgh, Scotland) | Read 823 articles with impact on ResearchGate, the professional network for scientists. S3 Fig. Characteristics of people who were in remission in 2019 compared to people who were not in remission of type 2 diabetes among people in Scotland who had at least 1 HbA1c 48 mmol/mol (6.5%) after diagnosis of type 2 diabetes and had at least 1 HbA1c recorded in 2019. Poster presentation at the 77, Bermingham ML, Colombo M, McGurnaghan S, Blackbourn L, Vukovi F, Pui Bakovi M, Lauc G, Agakov FA, Agakov AS, Hayward C, Klaric L, McKeigue PM, Colhoun HM, SDRNT1BIO investigators. Glucose-lowering agents for treating pre-existing and new-onset diabetes in kidney transplant recipients. Data were analysed using R version 3.4.4. Remission of type 2 diabetes was assessed between January 1, 2019 and December 31, 2019. The https:// ensures that you are connecting to the People who have not yet been prescribed drugs to treat diabetes may be the most appropriate group for clinicians to initiate discussions around remission and weight management options. 2022 Sep 12;13:968239. doi: 10.3389/fendo.2022.968239. Recognised body which has been HbA1c data at follow-up were available for 146 people in the intervention group and 139 people in the control group. RESEARCH DESIGN AND METHODSWe used a population-based national elec-tronic diabetes database for 35- to 84-year-olds in Scotland for 2001-2007 linked to mortality records. 2016;59(10):210613. Type 1 diabetes mellitus (T1DM) affects approximately 0.4-0.5% of the population. This highlights the need for a definitive and comprehensive consensus on the definition of type 2 diabetes remission that is clear for people with type 2 diabetes and healthcare professionals in all settings [8]. Our findings can be used to evaluate the impact of future initiatives on the prevalence of type 2 diabetes remission. People with previous history of dementia, end-stage renal disease, liver cirrhosis, cancer, or metastases in the last 5 years removed. Among the group were some of the charity's most passionate and dedicated fundraisers. The research states the increase will be driven by the world's ever . Long-term remission of type 2 diabetes after very-low-calorie restriction and related predictors. Abbreviations: Socio-economic differences in cardiovascular disease risk factor prevalence in people with type 2 diabetes in Scotland: a cross-sectional study. Of these, 35,321 (17%) did not have any HbA1c records for 2019 and a further 9,219 (4.5%) never had a record of an HbA1c value 48 mmol/mol (6.5%), leaving 162,316 people for the primary analysis, of whom 117,048 (72%) had complete data. Other potential options include use of estimated HbA1c; however, this is not established in routine clinical settings [7,30]. The National Health Service (NHS) in England and Scotland are currently introducing the use of very low calorie diets for obese people with type 2 diabetes in routine clinical care [14]. e1003828. Other endocrine conditions include disease of the thyroid gland, pituitary gland and adrenal glands. Diabetes research (Edinburgh, Scotland) | Read 823 articles with impact on ResearchGate, the professional network for scientists. We carried out a cross-sectional study estimating the prevalence of remission of type 2 dia- betes in all adults in Scotland aged 30 years diagnosed with type 2 diabetes and alive on December 31, 2019.