Long-Term Normoglycemic Remission in Black Newly Diagnosed NIDDM Subjects

Abstract

We have defined and characterized the natural history of spontaneous near-normoglycemic remission off of antidiabetic medication in 79 black NIDDM subjects. They had initially presented with plasma glucose levels of 37.8 ± 19.3 mmol/l. Baseline clinical metabolic and 8-year prospective data were obtained (51 men and 28 women, mean age 45 ± 10 years, islet-cell or GAD antibody negative). After hospitalization and intensive outpatient treatment, near-normoglycemic remission (fasting plasma glucose 6.1 ± 0.83 mmol/l and HbA_1c 0.95 ± 0.10 of upper limit of normal) occurred within 8 ± 10 months of insulin or sulfonylurea therapy. This was unrelated to the resolution of stress or significant weight loss (1.9 ± 4.97 kg). Metabolic studies performed during remission showed 17% normal, 33% impaired, and 50% diabetic glucose tolerance. Glucose disposal (1 mU · kg⁻¹ · min⁻¹) euglycemic insulin clamp with D-[3-³)H]glucose) was higher in the normal glucose tolerance group compared with the impaired and diabetic groups (37.8 ± 10.2 vs. 26.1 ± 10.7 and 26.7 ± 12.0 μmol · kg⁻¹ · min⁻¹; P < 0.05) despite similar BMIs in all three groups (28.8 ± 3.7 kg/m²). Insulin secretion was below the normal range. Of 79 patients, 27 relapsed. A Kaplan-Meier survival analysis gives a median time of 40 months to relapse. Higher presenting plasma glucose and male sex predicted earlier relapse. Near-normoglycemic remission may occur in up to 30% of black new-onset NIDDM patients. It appears to be associated with intensive initial glycemic regulation and may be a method of decreasing the development of microvascular complications in NIDDM.