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Special Article| Volume 46, ISSUE 8, P753-761.e8, December 2022

Remission of Type 2 Diabetes

Diabetes Canada Clinical Practice Guidelines Expert Working Group:
Published:November 11, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.10.004
      Type 2 diabetes remission is defined as achieving specified glycated hemoglobin (A1C) thresholds without any antihyperglycemic medications for a minimum of 3 months: remission to prediabetes (A1C between 6.0% and 6.4%) and remission to normal glucose concentrations (A1C <6.0%).
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      References

        • DeFronzo R.A.
        • Triplitt C.L.
        • Abdul-Ghani M.
        • Cersosimo E.
        Novel agents for the treatment of type 2 diabetes.
        Diabetes spectrum: A publication of the American Diabetes Association. 2014; 27: 100-112
        • Shaheen S.
        Fighting for a hand to hold: Confronting medical colonialism against Indigenous children in Canada.
        McGill-Queen’s University Press, Quebec2020
        • Truth, Canada RCo
        Truth and Reconciliation Commission of Canada: Calls to Action: Truth and Reconciliation.
        Commission of Canada, 2015
        • Sherifali D.
        • Rabi D.M.
        • McDonald C.G.
        • Butalia S.
        • Campbell D.J.T.
        • Hunt D.
        • et al.
        Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Methods.
        Can J Diabetes. 2018; 42: S6-S9
        • Jin S.
        • Bajaj H.
        • Brazeau A.S.
        • et al.
        Remission of type 2 diabetes: User’s guide.
        Can J Diabetes. 2022; 46: 762-774
        • Wharton S.
        • Pedersen S.D.
        • Lau D.C.W.
        • Sharma A.M.
        Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Weight Management in Diabetes.
        Can J Diabetes. 2018; 42: S124-S129
        • Stone J.A.
        • Houlden R.L.
        • Lin P.
        • Udell J.A.
        • Verma S.
        Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Cardiovascular Protection in People With Diabetes.
        Can J Diabetes. 2018; 42: S162-S169
        • Sievenpiper J.L.
        • Chan C.B.
        • Dworatzek P.D.
        • Freeze C.
        • Williams S.L.
        Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Nutrition Therapy.
        Can J Diabetes. 2018; 42: S64-S79
        • Sigal R.J.
        • Armstrong M.J.
        • Bacon S.L.
        • Boulé N.G.
        • Dasgupta K.
        • Kenny G.P.
        • et al.
        Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Physical Activity and Diabetes.
        Can J Diabetes. 2018; 42: S54-S63
        • Prebtani A.P.H.
        • Bajaj H.S.
        • Goldenberg R.
        • Mullan Y.
        Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Reducing the Risk of Developing Diabetes.
        Can J Diabetes. 2018; 42: S20-S26
        • Lipscombe L.
        • Butalia S.
        • Dasgupta K.
        • Eurich D.T.
        • MacCallum L.
        • Shah B.R.
        • et al.
        Pharmacologic glycemic management of type 2 diabetes in adults: 2020 update.
        Canadian Journal of Diabetes. 2020; 44: 575-591
        • Riddle M.C.
        • Cefalu W.T.
        • Evans P.H.
        • Gerstein H.C.
        • Nauck M.A.
        • Oh W.K.
        • et al.
        Consensus report: Definition and interpretation of remission in type 2 diabetes.
        Diabetic medicine: A journal of the British Diabetic Association. 2022; 39e14669
        • Riddle M.C.
        • Cefalu W.T.
        • Evans P.H.
        • Gerstein H.C.
        • Nauck M.A.
        • Oh W.K.
        • et al.
        Consensus report: Definition and interpretation of remission in type 2 diabetes.
        The Journal of Clinical Endocrinology and Metabolism. 2022; 107: 1-9
        • Riddle M.C.
        • Cefalu W.T.
        • Evans P.H.
        • Gerstein H.C.
        • Nauck M.A.
        • Oh W.K.
        • et al.
        Consensus Report: Definition and interpretation of remission in type 2 diabetes.
        Diabetes Care. 2021;
        • Riddle M.C.
        • Cefalu W.T.
        • Evans P.H.
        • Gerstein H.C.
        • Nauck M.A.
        • Oh W.K.
        • et al.
        Consensus report: Definition and interpretation of remission in type 2 diabetes.
        Diabetologia. 2021; 64: 2359-2366
      1. Diabetes Australia Position Statement on Type 2 Diabetes Remission.
        (October 2021. Accessed October 5, 2022.)
        • Captieux M.
        • Prigge R.
        • Wild S.
        • Guthrie B.
        Defining remission of type 2 diabetes in research studies: A systematic scoping review.
        PLoS Med. 2020; 17e1003396
        • Punthakee Z.
        • Goldenberg R.
        • Katz P.
        Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome.
        Can J Diabetes. 2018; 42: S10-S15
      2. Diabetes Canada Clinical Practice Guidelines: Processes Manual 2021.
        ([Available from:) (])
        • Ribaric G.
        • Buchwald J.N.
        • McGlennon T.W.
        Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: A systematic review and meta-analysis.
        Obes Surg. 2014; 24: 437-455
        • Committee ADAPP
        8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes—2022.
        Diabetes Care. 2021; 45: S113-S124
        • Aminian A.
        • Vidal J.
        • Salminen P.
        • Still C.D.
        • Nor Hanipah Z.
        • Sharma G.
        • et al.
        Late relapse of diabetes after bariatric surgery: Not rare, but not a failure.
        Diabetes Care. 2020; 43: 534-540
        • Kasama K.
        • Mui W.
        • Lee W.J.
        • Lakdawala M.
        • Naitoh T.
        • Seki Y.
        • et al.
        IFSO-APC consensus statements 2011.
        Obes Surg. 2012; 22: 677-684
        • Salminen P.
        • Gronroos S.
        • Helmio M.
        • Hurme S.
        • Juuti A.
        • Juusela R.
        • et al.
        Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss, Comorbidities, and Reflux at 10 Years in Adult Patients With Obesity: The SLEEVEPASS Randomized Clinical Trial.
        JAMA Surg. 2022;
        • Castellana M.
        • Procino F.
        • Biacchi E.
        • Zupo R.
        • Lampignano L.
        • Castellana F.
        • et al.
        Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy for Remission of Type 2 Diabetes.
        The Journal of clinical endocrinology and metabolism. 2021; 106: 922-933
        • Borgeraas H.
        • Hofsø D.
        • Hertel J.K.
        • Hjelmesæth J.
        Comparison of the effect of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials.
        Obesity Reviews. 2020; 21e13011
        • Madadi F.
        • Jawad R.
        • Mousati I.
        • Plaeke P.
        • Hubens G.
        Remission of Type 2 Diabetes and Sleeve Gastrectomy in Morbid Obesity: a Comparative Systematic Review and Meta-analysis.
        Obes Surg. 2019; 29: 4066-4076
        • Guraya S.Y.
        • Strate T.
        Surgical outcome of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass for resolution of type 2 diabetes mellitus: A systematic review and meta-analysis.
        World journal of gastroenterology : WJG. 2020; 26: 865-876
        • Müller-Stich B.P.
        • Senft J.D.
        • Warschkow R.
        • Kenngott H.G.
        • Billeter A.T.
        • Vit G.
        • et al.
        Surgical versus medical treatment of type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis.
        Annals of surgery. 2015; 261: 421-429
        • Sha Y.
        • Huang X.
        • Ke P.
        • Wang B.
        • Yuan H.
        • Yuan W.
        • et al.
        Laparoscopic Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy for Type 2 Diabetes Mellitus in Nonseverely Obese Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
        Obes Surg. 2020; 30: 1660-1670
        • Cohen R.
        • Le Roux C.W.
        • Junqueira S.
        • Ribeiro R.A.
        • Luque A.
        Roux-En-Y Gastric Bypass in Type 2 Diabetes Patients with Mild Obesity: a Systematic Review and Meta-analysis.
        Obes Surg. 2017; 27: 2733-2739
        • Chen Y.
        • Zeng G.
        • Tan J.
        • Tang J.
        • Ma J.
        • Rao B.
        Impact of roux-en Y gastric bypass surgery on prognostic factors of type 2 diabetes mellitus: meta-analysis and systematic review.
        Diabetes/metabolism research and reviews. 2015; 31: 653-662
        • Conte C.
        • Lapeyre-Mestre M.
        • Hanaire H.
        • Ritz P.
        Diabetes Remission and Relapse After Bariatric Surgery: a Nationwide Population-Based Study.
        Obes Surg. 2020; 30: 4810-4820
        • Elshaer A.M.
        • Almerie M.Q.
        • Pellen M.
        • Jain P.
        Relapse of Diabetes After Roux-en-Y Gastric Bypass for Patients With Obesity: 12 Years Follow-up Study.
        Obes Surg. 2020; 30: 4834-4839
        • Lean M.E.J.
        • Leslie W.S.
        • Barnes A.C.
        • Brosnahan N.
        • Thom G.
        • McCombie L.
        • et al.
        Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial.
        Lancet Diabetes Endocrinol. 2019; 7: 344-355
        • Lean M.E.
        • Leslie W.S.
        • Barnes A.C.
        • Brosnahan N.
        • Thom G.
        • McCombie L.
        • et al.
        Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.
        Lancet. 2018; 391: 541-545
        • Taheri S.
        • Zaghloul H.
        • Chagoury O.
        • Elhadad S.
        • Ahmed S.H.
        • El Khatib N.
        • et al.
        Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial.
        Lancet Diabetes Endocrinol. 2020; 8: 477-489
        • Ried-Larsen M.
        • Johansen M.Y.
        • MacDonald C.S.
        • Hansen K.B.
        • Christensen R.
        • Wedell-Neergaard A.S.
        • et al.
        Type 2 diabetes remission 1 year after an intensive lifestyle intervention: A secondary analysis of a randomized clinical trial.
        Diabetes Obes Metab. 2019; 21: 2257-2266
        • Gregg E.W.
        • Chen H.
        • Wagenknecht L.E.
        • Clark J.M.
        • Delahanty L.M.
        • Bantle J.
        • et al.
        Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes.
        Jama. 2012; 308: 2489-2496
        • Hoffmann T.C.
        • Glasziou P.P.
        • Boutron I.
        • et al.
        Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide.
        BMJ. 2014; 348: g1687https://doi.org/10.1136/bmj.g1687
        • Leslie W.S.
        • Ford I.
        • Sattar N.
        • Hollingsworth K.G.
        • Adamson A.
        • Sniehotta F.F.
        • et al.
        The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial.
        BMC Fam Pract. 2016; 17: 20
        • Taylor R.
        • Al-Mrabeh A.
        • Sattar N.
        Understanding the mechanisms of reversal of type 2 diabetes.
        Lancet Diabetes Endocrinol. 2019; 7: 726-736
        • Taylor R.
        • Leslie W.S.
        • Barnes A.C.
        • Brosnahan N.
        • Thom G.
        • McCombie L.
        • et al.
        Clinical and metabolic features of the randomised controlled Diabetes Remission Clinical Trial (DiRECT) cohort.
        Diabetologia. 2018; 61: 589-598
        • Taylor R.
        Calorie restriction and reversal of type 2 diabetes.
        Expert review of endocrinology & metabolism. 2016; 11: 521-528
        • Taylor R.
        Type 2 diabetes: Etiology and reversibility.
        Diabetes care. 2013; 36: 1047-1055
        • Johansen M.Y.
        • MacDonald C.S.
        • Hansen K.B.
        • et al.
        Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial.
        JAMA. 2017 Aug 15; 318: 637-646
        • Ried-Larsen M.
        • Christensen R.
        • Hansen K.B.
        • et al.
        Head-to-head comparison of intensive lifestyle intervention (U-TURN) versus conventional multifactorial care in patients with type 2 diabetes: protocol and rationale for an assessor-blinded, parallel group and randomised trial.
        BMJ Open. 2015 Dec 9; 5e009764
      3. Diabetes Canada Position Statement on Low-Carbohydrate Diets for Adults With Diabetes: A Rapid Review.
        Can J Diabetes. 2020; 44: 295-299
        • Athinarayanan S.J.
        • Adams R.N.
        • Hallberg S.J.
        • McKenzie A.L.
        • Bhanpuri N.H.
        • Campbell W.W.
        • et al.
        Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial.
        Front Endocrinol (Lausanne). 2019; 10: 348
        • Hallberg S.J.
        • McKenzie A.L.
        • Williams P.T.
        • Bhanpuri N.H.
        • Peters A.L.
        • Campbell W.W.
        • et al.
        Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study.
        Diabetes Ther. 2018;
        • Goldenberg J.Z.
        • Day A.
        • Brinkworth G.D.
        • Sato J.
        • Yamada S.
        • Jönsson T.
        • et al.
        Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data.
        Bmj. 2021; 372: m4743
        • Kramer C.K.
        • Zinman B.
        • Retnakaran R.
        Short-term intensive insulin therapy in type 2 diabetes mellitus: a systematic review and meta-analysis.
        Lancet Diabetes Endocrinol. 2013; 1: 28-34
        • Weng J.
        • Li Y.
        • Xu W.
        • Shi L.
        • Zhang Q.
        • Zhu D.
        • et al.
        Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial.
        Lancet. 2008; 371: 1753-1760
        • McInnes N.
        • Hall S.
        • Sultan F.
        • Aronson R.
        • Hramiak I.
        • Harris S.
        • et al.
        Remission of Type 2 Diabetes Following a Short-term Intervention With Insulin Glargine, Metformin, and Dapagliflozin.
        The Journal of Clinical Endocrinology & Metabolism. 2020; 105: 2532-2540
        • McInnes N.
        • Hall S.
        • Hramiak I.
        • Sigal R.J.
        • Goldenberg R.
        • Gupta N.
        • et al.
        Remission of Type 2 Diabetes Following a Short-term Intensive Intervention With Insulin Glargine, Sitagliptin, and Metformin: Results of an Open-label Randomized Parallel-Design Trial.
        Diabetes care. 2022; 45: 178-185
        • Kvedar J.C.
        • Fogel A.L.
        • Elenko E.
        • Zohar D.
        Digital medicine's march on chronic disease.
        Nature biotechnology. 2016; 34: 239-246
        • Tjam E.Y.
        • Sherifali D.
        • Steinacher N.
        • Hett S.
        Physiological Outcomes of an Internet Disease Management Program vs. In-person Counselling:A Randomized, Controlled Trial.
        Can J Diabetes. 2006; 30 (Epub 2012 Dec 10): 397-405https://doi.org/10.1016/S1499-2671(06)04008-1
        • Berman M.A.
        • Guthrie N.L.
        • Edwards K.L.
        • Appelbaum K.J.
        • Njike V.Y.
        • Eisenberg D.M.
        • et al.
        Change in Glycemic Control With Use of a Digital Therapeutic in Adults With Type 2 Diabetes: Cohort Study.
        JMIR Diabetes. 2018; 3: e4
        • Buse J.B.
        • Caprio S.
        • Cefalu W.T.
        • Ceriello A.
        • Del Prato S.
        • Inzucchi S.E.
        • et al.
        How do we define cure of diabetes?.
        Diabetes care. 2009; 32: 2133-2135
        • Day S.
        • Shah V.
        • Kaganoff S.
        • Powelson S.
        • Mathews S.C.
        Assessing the Clinical Robustness of Digital Health Startups: Cross-sectional Observational Analysis.
        J Med Internet Res. 2022; 24e37677
        • Cavero-Redondo I.
        • Peleteiro B.
        • Álvarez-Bueno C.
        • Rodriguez-Artalejo F.
        • Martínez-Vizcaíno V.
        Glycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: a systematic review and meta-analysis.
        BMJ open. 2017; 7e015949
        • Li F.-R.
        • Zhang X.-R.
        • Zhong W.-F.
        • Li Z.-H.
        • Gao X.
        • Kraus V.B.
        • et al.
        Glycated Hemoglobin and All-Cause and Cause-Specific Mortality Among Adults With and Without Diabetes.
        The Journal of Clinical Endocrinology & Metabolism. 2019; 104: 3345-3354
        • Ding L.
        • Fan Y.
        • Li H.
        • Zhang Y.
        • Qi D.
        • Tang S.
        • et al.
        Comparative effectiveness of bariatric surgeries in patients with obesity and type 2 diabetes mellitus: A network meta-analysis of randomized controlled trials.
        Obesity Reviews. 2020; 21e13030
        • Cui B.B.
        • Wang G.H.
        • Li P.Z.
        • Li W.Z.
        • Zhu L.Y.
        • Zhu S.H.
        Long-term outcomes of Roux-en-Y gastric bypass versus medical therapy for patients with type 2 diabetes: a meta-analysis of randomized controlled trials.
        Surg Obes Relat Dis. 2021 Jul; 17 (Epub 2021 Mar 9. PMID: 33863632): 1334-1343https://doi.org/10.1016/j.soard.2021.03.001
        • Cresci B.
        • Cosentino C.
        • Monami M.
        • Mannucci E.
        Metabolic surgery for the treatment of type 2 diabetes: A network meta-analysis of randomized controlled trials.
        Diabetes Obes Metab. 2020 Aug; 22 (Epub 2020 May 4. PMID: 32243058): 1378-1387https://doi.org/10.1111/dom.14045
        • Khorgami Z.
        • Shoar S.
        • Saber A.A.
        • Howard C.A.
        • Danaei G.
        • Sclabas G.M.
        Outcomes of Bariatric Surgery Versus Medical Management for Type 2 Diabetes Mellitus: a Meta-Analysis of Randomized Controlled Trials.
        Obes Surg. 2019 Mar; 29 (PMID:30402804): 964-974https://doi.org/10.1007/s11695-018-3552-x