Can type 2 diabetes go into remission?

Remission of type 2 diabetes is a defined clinical state, not a marketing phrase. An expert group convened by the ADA, EASD, Diabetes UK and the Endocrine Society defined it in 2021 as "a return of HbA1c to less than 6.5 percent that occurs spontaneously or following an intervention and that persists for at least 3 months in the absence of usual glucose-lowering pharmacotherapy". The word cure was deliberately not used.

What the DiRECT trial showed

DiRECT randomized primary care practices in Scotland and England. Participants stopped their diabetes medications and used a formula diet of 825 to 853 kcal a day for three to five months, then reintroduced food with structured support. At 12 months, 46 percent of the intervention group were in remission compared with 4 percent of controls. Among those who lost 15 kg or more, 86 percent achieved remission. At 24 months, 36 percent of the intervention group remained in remission versus 3 percent of controls.

How durable is remission

Remission tracks weight. In the five year DiRECT extension published in 2024, 13 percent of intervention participants with data at five years were still in remission, and those who stayed in remission had maintained an average weight loss of 8.9 kg. That is a smaller number than the headline, and it is the honest one. Remission is a state that has to be held, in the same way blood pressure control has to be held.

Who is most likely to achieve it

The people most likely to reach remission are those diagnosed recently, those with higher body weight to lose, and those not yet on insulin. DiRECT enrolled adults aged 20 to 65 diagnosed within the previous six years, with a BMI of 27 to 45, and not on insulin. Longer standing diabetes reflects more beta cell loss, which is the part weight loss cannot fully undo. Metabolic surgery achieves remission in a substantial proportion of people as well, and is the option with the largest and most durable weight loss.

If remission is your goal, ask three questions at your next visit: how long have I had diabetes, am I on medications that need to be reduced as weight falls, and what weight loss target are we aiming for. Then ask for HbA1c to be rechecked no sooner than three months after glucose lowering medication is stopped, which is what the consensus definition requires, and at least yearly after that.