How Do We Define Cure of Diabetes?
- John B. Buse, MD, PHD1,
- Sonia Caprio, MD2,
- William T. Cefalu, MD3,
- Antonio Ceriello, MD4,
- Stefano Del Prato, MD5,
- Silvio E. Inzucchi, MD6,
- Sue McLaughlin, BS, RD, CDE, CPT7,
- Gordon L. Phillips II, MD8,
- R. Paul Robertson, MD9,
- Francesco Rubino, MD10,
- Richard Kahn, PHD11 and
- M. Sue Kirkman, MD11
- 1Division of Endocrinology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina;
- 2Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut;
- 3Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, Louisiana;
- 4University of Warwick, Warwick Medical School, Coventry, U.K.;
- 5Department of Endocrinology & Metabolism, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy;
- 6Section of Endocrinology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut;
- 7Nebraska Medical Center, Omaha, Nebraska;
- 8Division of Hematology/Oncology, Department of Medicine, and the Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, New York;
- 9Pacific Northwest Diabetes Research Institute and University of Washington, Seattle, Washington;
- 10Section of Metabolic Surgery, Department of Surgery, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York;
- 11American Diabetes Association, Alexandria, Virginia.
- Corresponding author: M. Sue Kirkman, skirkman{at}diabetes.org.
The mission of the American Diabetes Association is “to prevent and cure diabetes and to improve the lives of all people affected by diabetes.” Increasingly, scientific and medical articles (1) and commentaries (2) about diabetes interventions use the terms “remission” and “cure” as possible outcomes. Several approved or experimental treatments for type 1 and type 2 diabetes (e.g., pancreas or islet transplants, immunomodulation, bariatric/metabolic surgery) are of curative intent or have been portrayed in the media as a possible cure. However, defining remission or cure of diabetes is not as straightforward as it may seem. Unlike “dichotomous” diseases such as many malignancies, diabetes is defined by hyperglycemia, which exists on a continuum and may be impacted over a short time frame by everyday treatment or events (medications, diet, activity, intercurrent illness). The distinction between successful treatment and cure is blurred in the case of diabetes. Presumably improved or normalized glycemia must be part of the definition of remission or cure. Glycemic measures below diagnostic cut points for diabetes can occur with ongoing medications (e.g., antihyperglycemic drugs, immunosuppressive medications after a transplant), major efforts at lifestyle change, a history of bariatric/metabolic surgery, or ongoing procedures (such as repeated replacements of endoluminal devices). Do we use the terms remission or cure for all patients with normal glycemic measures, regardless of how this is achieved?
A consensus group comprised of experts in pediatric and adult endocrinology, diabetes education, transplantation, metabolism, bariatric/metabolic surgery, and (for another perspective) hematology-oncology met in June 2009 to discuss these issues. The group considered a wide variety of questions, including whether it is ever accurate to say that a chronic illness is cured; what the definitions of management, remission, or cure might be; whether goals of managing comorbid conditions revert to those of patients without diabetes if someone is …
