REMISSION IN NON-INSULIN-DEPENDENT DIABETES-MELLITUS - CLINICAL CHARACTERISTICS OF REMISSION AND RELAPSE IN BLACK PATIENTS

Normoglycemic remission has been observed in black non-insulin-dependent diabetic individuals. Thirty-three patients presented with severe hyperglycemia (mean glucose 682 mg/dl) and were hospitalized for initial treatment. Following intensive outpatient therapy including insulin or sulfonylurea for 0.25 to 96 weeks, they became normoglycemic without pharmacologic treatment. This state was characterized by normal glycosylated hemoglobin levels in 29 of 30 patients and fasting plasma glucose levels of ≤ 115 mg/dl in 25 of 33 patients. During clinical remission these individuals were characterized as being lean to moderately obses (body mass index <30.5 kg/m), relatively young (45 years of age), and largely male (male:female ratio was 2:1). Thirty percent of the patients underwent normoglycemic remission after 3 months of treatment, 64% within 6 months, and 85% within 12 months. normoglycemic remission was not related to weight loss or amelioration of stress and lasted from several months to as long 97 months. The results of the oral glucose tolerance test during remission showed that 9 had normal, 7 had impaired, and 17 had diabetic glucose tolerance. Thirteen of the 33 patients relapsed and developed hyperglycemia after a mean of 24.9 months. Relapse was not associated with weight gain or acute stress. islet cell antibodies were uniformly absent, implying that these individuals did not have an autoimmune form of diabetes. It is not known if remission in non-insulin-dependent diabetes is unique to the black population. Neither the prevalence nor the mechanism of the development of remission is known at this time.