Prevention of T2DM/early remission from T2DM

Question 1

How can Remission of Diabetes be achieved?

Answer 1

in T2D- glucose control <48mmol/mol HbA1C without the use of medication

Question 2

What are the clinical concerns with diabetes remission- 1

Answer 2

1. The frontline glucose lowering therapy in T2D is metformin.

This has benefits on cardiovascular health
and so some clinicians are concerned that stopping this medication may lose that protection.

Question 3

What are the clinical concerns with diabetes remission- 2

Answer 3

2. Will telling people they are in remission induce poorer lifestyle choices and lose these individuals from the diabetes care system?

Question 4

What are the clinical concerns with diabetes remission-3

Answer 4

3. It’s really important for people in remission to get regular healthcare checks, so any complications can
   be monitored and any signs of type 2 diabetes coming back can be caught early.

Around 10% of DiRECT participants revert to T2D glucose levels each year after ending programme

Question 5

What is the evidence that T2DM can be PREVENTED?

Answer 5

Weight loss in people with BMI>30 reduces risk of developing T2D (16% for every Kg weight loss)

Question 6

What are the barriers to Prevention of T2DM and how can they be overcome (4)

Answer 6

1. How do you identify and engage people at high risk of getting diabetes?

Screen for impaired glucose tolerance (HbA1C), other risk factors (eg genetics, GDM,
BP, cardiovascular disease)

2. How do you alter the obesogenic environment?

eg. Sugar tax. Always need to have clear evidence base and buy-in from Govt and food
industry

3.How do you deal with health inequalities?

Digital innovations and local champions? Use community pharmacy. No easy fix.

4.How do you evaluate if the programme is working?

High quality data collection- joined up national approach to intervention allocations and data collections. NHS as a research Facility.