Influencing factors of type 2 diabetes remission: a systematic review and meta-analysis
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Siwen Cheng1, Jinying Chen2, Xinlu Zhang3
1Changchun University of Chinese Medicine, Changchun, China.
Purpose:
To identify factors influencing type 2 diabetes mellitus (T2DM) remission and compare differences across intervention types and remission criteria.
Methods:
T2DM remission was defined as HbA1c < 6.5% (48 mmol/mol), measured at least 3 months after cessation of glucose-lowering pharmacotherapy. Relevant literature on factors influencing T2DM remission was searched in English-language databases, with the search updated through March 2026. Meta-analysis was performed using Review Manager 5.4 and Stata 18.0 software.
Results:
A total of 36 studies were included. Higher fasting plasma glucose (OR = 0.99, 95% CI = [0.99, 1.00], P < 0.001), higher glycated hemoglobin (OR = 0.91, 95% CI = [0.88, 0.94], P < 0.001), longer disease duration (OR = 0.89, 95% CI = [0.88, 0.90], P < 0.001), and a greater number of oral antidiabetic agents (OR = 0.56, 95% CI = [0.38, 0.81], P = 0.002) were associated with lower odds of remission. A greater percentage of total weight loss was associated with higher odds of remission (OR = 1.05, 95% CI = [1.04, 1.07], P < 0.001). In surgical interventions, a higher body mass index (OR = 1.05, 95% CI = [1.02, 1.08], P = 0.002) was associated with higher odds of remission, whereas older age (OR = 0.96, 95% CI = [0.94, 0.98], P < 0.001) and insulin use (OR = 0.34, 95% CI = [0.23, 0.52], P < 0.001) were associated with lower odds of remission. In non-surgical interventions, alcohol cessation was associated with higher odds of remission (OR = 1.14, 95% CI = [1.05, 1.26], P < 0.001), while factors influencing lower odds of remission included smoking (OR = 0.90, 95% CI = [0.86, 0.94], P < 0.001), continued alcohol consumption (OR = 0.90, 95% CI = [0.84, 0.95], P < 0.001), and a higher body mass index (OR = 0.89, 95% CI = [0.86, 0.92], P < 0.001). Gender, race/ethnicity, physical exercise, intermittent fasting, HOMA-IR and C-peptide level were not associated with T2DM remission.
Conclusion:
T2DM remission is influenced by multiple factors, with BMI showing opposite associations by intervention type. Future large-scale, prospective studies are needed to validate these findings.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261295582.
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