Realisation of Remission of Diabetes Using Pharmacotherapy (DiaRem-1).

Introduction: Type 2 diabetes mellitus has traditionally been considered a lifelong disease, with treatment focused on glycaemic control and complication prevention. Emerging evidence suggests that targeting glucolipotoxicity and insulin resistance may restore beta-cell function, potentially leading to remission. This study aimed to evaluate the feasibility of achieving diabetes remission through pharmacotherapy by promoting weight loss and maintaining strict glycaemic control over a 3-month period.

Methods: This is a single-centre, open-label, randomised controlled trial conducted at a tertiary care center in India, with adult subjects with type 2 diabetes mellitus <5 years duration and HbA1c <8.5% randomised to an intervention arm using liraglutide, dapagliflozin and metformin, and a control arm using vildagliptin, glimepiride and metformin. The subjects were treated for 3 months followed by an off-treatment period for 3 months to assess for remission of diabetes.

Results: Two hundred thirty-six subjects were assessed for eligibility and 29 subjects underwent randomisation. Fourteen subjects were randomised to the intervention arm and 15 subjects were randomised to the control arm. Twenty-three of the 29 recruited subjects completed the trial. At the end of the off-treatment period, nine patients (31.04%) were in remission, with 4 out of 14 patients (28.57%) in the intervention arm and 5 out of 15 patients (33.33%) in the control arm maintaining HbA1c less than 6.5% without any treatment. No baseline clinical or biochemical parameters were found to be reliable predictors of remission.

Conclusion: This trial provides evidence that pharmacotherapy targeting tight glycaemic control on an outpatient basis is effective in achieving diabetes remission.