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Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study
Biochemical remission of type 2 diabetes is achievable through dietary changes, physical activity and subsequent weight loss. We aim to identify distinct diabetes remission trajectories in a large population-based cohort over seven-years follow-up and to examine associations between remission trajec...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10464964/ https://www.ncbi.nlm.nih.gov/pubmed/37643199 http://dx.doi.org/10.1371/journal.pone.0290791 |
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author | Dambha-Miller, Hajira Hounkpatin, Hilda O. Stuart, Beth Farmer, Andrew Griffin, Simon |
author_facet | Dambha-Miller, Hajira Hounkpatin, Hilda O. Stuart, Beth Farmer, Andrew Griffin, Simon |
author_sort | Dambha-Miller, Hajira |
collection | PubMed |
description | Biochemical remission of type 2 diabetes is achievable through dietary changes, physical activity and subsequent weight loss. We aim to identify distinct diabetes remission trajectories in a large population-based cohort over seven-years follow-up and to examine associations between remission trajectories and diabetes complications. Group-based trajectory modelling examined longitudinal patterns of HbA(1c) level (adjusting for remission status) over time. Multivariable Cox models quantified the association between each remission trajectory and microvascular complications, macrovascular complications, cardiovascular (CVD) events and all-cause mortality. Four groups were assigned. Group 1 (8,112 [13.5%]; achieving HbA(1c) <48 mmol/mol (6.5%) followed by increasing HbA(1c) levels); Group 2 (6,369 [10.6%]; decreasing HbA(1c) levels >48 mmol/mol (6.5%)); Group 3 (36,557 [60.6%]; stable high HbA(1c) levels); Group 4 (9,249 [15.3%]; stable low HbA(1c) levels (<48mmol/mol or <6.5%)). Compared to Group 3, Groups 1 and 4 had lower risk of microvascular complications (aHRs (95% CI): 0.65 (0.61–0.70), p-value <0.001;0.59 (0.55–0.64) p-value<0.001, respectively)), macrovascular complications (aHRs (95% CI): 0.83 (0.75–0.92), p-value<0.001; 0.66 (0.61–0.71), p-value<0.001) and CVD events (aHRs (95% CI): 0.74(0.67–0.83), p-value<0.001; 0.67(0.61–0.73), p-vlaue<0.001). Risk of CVD outcomes were similar for Groups 2 and 3. Compared to Group 3, Group 1 (aHR: 0.82(95% CI: 0.76–0.89)) had lower risk of mortality, but Group 4 had higher risk of mortality (aHR: 1.11(95% CI: 1.03–1.19)). Risk of CVD outcomes vary by pattern of remission over time, with lowest risk for those in remission longer. People who achieve remission, even for shorter periods of time, continue to benefit from this lower exposure to hyperglycaemia, which may, in turn, lower the risk of CVD outcomes including mortality. |
format | Online Article Text |
id | pubmed-10464964 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-104649642023-08-30 Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study Dambha-Miller, Hajira Hounkpatin, Hilda O. Stuart, Beth Farmer, Andrew Griffin, Simon PLoS One Research Article Biochemical remission of type 2 diabetes is achievable through dietary changes, physical activity and subsequent weight loss. We aim to identify distinct diabetes remission trajectories in a large population-based cohort over seven-years follow-up and to examine associations between remission trajectories and diabetes complications. Group-based trajectory modelling examined longitudinal patterns of HbA(1c) level (adjusting for remission status) over time. Multivariable Cox models quantified the association between each remission trajectory and microvascular complications, macrovascular complications, cardiovascular (CVD) events and all-cause mortality. Four groups were assigned. Group 1 (8,112 [13.5%]; achieving HbA(1c) <48 mmol/mol (6.5%) followed by increasing HbA(1c) levels); Group 2 (6,369 [10.6%]; decreasing HbA(1c) levels >48 mmol/mol (6.5%)); Group 3 (36,557 [60.6%]; stable high HbA(1c) levels); Group 4 (9,249 [15.3%]; stable low HbA(1c) levels (<48mmol/mol or <6.5%)). Compared to Group 3, Groups 1 and 4 had lower risk of microvascular complications (aHRs (95% CI): 0.65 (0.61–0.70), p-value <0.001;0.59 (0.55–0.64) p-value<0.001, respectively)), macrovascular complications (aHRs (95% CI): 0.83 (0.75–0.92), p-value<0.001; 0.66 (0.61–0.71), p-value<0.001) and CVD events (aHRs (95% CI): 0.74(0.67–0.83), p-value<0.001; 0.67(0.61–0.73), p-vlaue<0.001). Risk of CVD outcomes were similar for Groups 2 and 3. Compared to Group 3, Group 1 (aHR: 0.82(95% CI: 0.76–0.89)) had lower risk of mortality, but Group 4 had higher risk of mortality (aHR: 1.11(95% CI: 1.03–1.19)). Risk of CVD outcomes vary by pattern of remission over time, with lowest risk for those in remission longer. People who achieve remission, even for shorter periods of time, continue to benefit from this lower exposure to hyperglycaemia, which may, in turn, lower the risk of CVD outcomes including mortality. Public Library of Science 2023-08-29 /pmc/articles/PMC10464964/ /pubmed/37643199 http://dx.doi.org/10.1371/journal.pone.0290791 Text en © 2023 Dambha-Miller et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Dambha-Miller, Hajira Hounkpatin, Hilda O. Stuart, Beth Farmer, Andrew Griffin, Simon Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study |
title | Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study |
title_full | Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study |
title_fullStr | Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study |
title_full_unstemmed | Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study |
title_short | Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study |
title_sort | type 2 diabetes remission trajectories and variation in risk of diabetes complications: a population-based cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10464964/ https://www.ncbi.nlm.nih.gov/pubmed/37643199 http://dx.doi.org/10.1371/journal.pone.0290791 |
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