Clinical practice in recent years has shown that some people with type 2 diabetes can stop taking hypoglycemic drugs after taking certain interventions. Blood sugar is still at a normal or near-normal level. At present, most scholars use remission to describe the continuous improvement of metabolism to a near-normal state in patients with type 2 diabetes.

Typical case: Liu Xiaopang, weighing 200 catties. Because the random blood sugar measured by self-test was as high as 20mmol/L, I went to the doctor. At that time, the venous blood glucose in the hospital was 24mmol/L, and the urine ketone was suspected to be positive. Fortunately, I went to the doctor in time. Diabetic ketoacidosis coma, life-threatening.

Therapeutic plan: After admission, intensive treatment with an insulin pump was used. After only three days, the blood sugar was controlled to normal, and the dose was gradually reduced. At the same time, under the guidance of a nutritionist , Scientifically adjust the diet to cooperate with insulin pump therapy.

When the total daily insulin pump decreased to less than 30 units, the pump was withdrawn and the oral hypoglycemic drug treatment was changed. Initially, one tablet of glimepiride in the morning and one tablet in the evening, and one tablet of metformin in the morning, one tablet in the evening, one tablet in the morning, one tablet in the evening, one tablet in the morning, one tablet in the evening, one tablet in the morning, one tablet in the evening, one tablet in the morning, one tablet in the evening, one tablet in the morning, one tablet in the evening, one tablet in the morning, one tablet in the evening, one tablet in the morning, one tablet in the evening on the metformin, and one tablet in the morning, one tablet in the evening, and one tablet in the morning, one tablet in the evening, one tablet in the morning, one tablet in the evening, one tablet in the morning, one tablet in the evening, one tablet in the morning, one tablet in the evening on the metformin. After one week, the blood sugar remained stable. One month later, the blood sugar is still stable after stopping the hypoglycemic drugs. At this time, some people say that it is entering the “honeymoon period of the disease”, and the disease will recur soon.

But after Liu Xiaopang was discharged from the hospital, he insisted on a healthy and scientific diet and living habits with tenacious perseverance: he walked to work every day, and avoided eating high-calorie and fried foods. When eating, eat in the order of the soup first, then the dish and the staple food last. Reduce sedentary time, exercise regularly, and soon lose weight significantly, and blood sugar remains normal and stable after half a year. The doctor judged that Xiao Liu’s diabetes has been relieved.

How does type 2 diabetes count as remission?

Criteria for remission of type 2 diabetes (called “definition” in some literature) are not yet uniform.

A consensus statement issued by the American Diabetes Association (ADA) in 2009 recommended that the state of diabetes free from drug treatment be called remission, and further divided into partial remission, complete remission and long-term relief. Partial remission refers to glycated hemoglobin (HbA1c) <6.5%, fasting blood glucose 5.6-6.9 mmol/L (100-125 mg/dl) and maintained for more than 1 year after discontinuation of antidiabetic drugs.

In 2021, the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), the American Society of Endocrinology and the British Diabetes Association released a consensus report on remission of type 2 diabetes, which is consistent with the 2009 edition. The difference between the ADA consensus statement is that the 2021 version of the consensus report recommends that partial remission, complete remission and long-term remission will no longer be distinguished, and the remission standard established is also different from the 2009 version of the consensus statement. HbA1c<6.5% in the case of discontinuation of hypoglycemic drugs Remission is considered to persist for at least 3 months.

Author: Li Changqi, Chief Physician, Department of Endocrinology, Beijing Hepingli Hospital