REMISSION IN TYPE TWO DIABETES MELLITUS: FACTORS ASSOCIATED WITH CLINICAL REMISSION IN EGYPTIAN PATIENTS.
 Magdy Mohamed Allam 1, Hanaa Tarek El-Zawawy 2 
1Internal Medicine department, Alexandria University Student Hospital (AUSH); 2 Internal Medicine department, Faculty of Medicine. Alexandria University, Egypt
Background: The rate of Type 2 diabetes remission has been observed during last few years in Endocrinology unit, Alexandria University hospitals. Thus it was interesting to study the causes of increasing incidence of type 2 DM remission. Also, we search for earlier and potent predictors for DM remission.
Aim of the work: To investigate factors that are associated with remission of type 2 DM in Egyptian type 2 diabetes patients.
Patients and methods: This study is a retrospective cohort study which included 63 patients which developed type 2 diabetes partially or complete remission (defined according to ADA criteria) between year 2012 and 2015. Only Patients with type 2 diabetes remission who completed one year of follow-up were reviewed retrospectively. We excluded subjects based on the following criteria: type 1 diabetes, had a history of bariatric surgery, maintained on hyper glycemic drugs (eg. Steroids) and patients with organ (heart, renal, and liver) failure.
Data in this analysis were collected from records at the first visit, including history, physical examination, hematological, biochemical profile, type and duration of treatment. All Patients Were motivated to life style modification, then at time of stoppage of treatment the change in body weight, Hb A1C %, and lipid profile were detected. One year after remission FBG, post 75glucose plasma glucose, and HbA1C were done to assure maintenance of remission. 
Results:
       Of the 63 patients, 75 %were females and 25% were males. The mean age was 51.5 years and the mean body mass index (BMI) was 34.22kg/m2. In the first visit HbA1c varied from 6.5 to 12.4% (mean = 8.867± 1.4912). The mean duration of treatment till remission (26.4± 33.1 month); with 60 % of remission cases after 24 months of treatment 
        After adjusting for demographic and clinical characteristics, Cox proportional hazards model and Receiver operating characteristic (ROC) curve analysis revealed that factors associated with T2DM remission included younger age (<50years), female sex, nonsmokers, shorter duration since diagnosis of diabetes (< 5.2 years), lower baseline HbA1c level (<8.5%) and higher HDL (> 45.6 mg/dl), and who were initially treated with 2000 mg Metformin and Vildagliptin, but did not start with insulin therapy. 
CONCLUSIONS; 
In young female patients with type 2 diabetes less than five years duration, if the initial HbA1C is less than 8.5% and HDL more than 45.6mg/dl, we should seek a remission by intensive life style modification in association with metformin 2000mg and vildagliptin 100 mg.

Remission in type two diabetes mellitus: factors associated with clinical remission in Egyptian patients