A realistic approach to type 2 diabetes remission

For many individuals living with type 2 diabetes, the notion of remission, where blood glucose levels return to a range not indicative of diabetes without the need for glucose-lowering medication, can sound like a dream come true. In recent years, research has suggested that remission is possible for some individuals, especially with early intervention and lifestyle changes.¹^,⁵ However, it’s important to approach this concept with caution, realism, and above all, a commitment to long-term sustainable health, not just short-term results.⁵

What is type 2 diabetes remission

Remission from type 2 diabetes is defined as maintaining blood glucose levels below an HbA1c of 6.5% (48 mmol/mol) for at least six months, without glucose-lowering medication.¹^,⁶ Diabetes remission is not a cure, diabetes can return, but it does represent a state of improved metabolic health.

Some people achieve remission through significant weight loss, often after bariatric surgery or very low-calorie diets (VLCD).²^,⁶ Others may reach remission through gradual, sustainable changes in diet and activity, especially in the earlier stages of the condition. However, not everyone will achieve remission, and that’s okay. Managing blood glucose and preventing complications remain worthwhile and meaningful goals.¹^,⁶

Remission: The debate continues

While the potential for remission is promising, not all researchers agree that it should be a primary or universal goal. A 2023 study published in Frontiers in Endocrinology—Type 2 Diabetes Remission: A Critique of Current Definitions and Frameworks raises important questions about the consistency and sustainability of remission claims.⁵ The study highlights that there are nearly 100 different definitions of remission used in scientific literature, making it difficult to draw firm conclusions about how many people truly achieve it, or for how long.

The authors argue that focusing too narrowly on remission may overlook the chronic, progressive nature of type 2 diabetes and create unrealistic expectations.¹ In some cases, people may feel like they’ve failed if remission isn’t achieved, despite making significant health improvements. The study also notes that most people who achieve remission do so through substantial weight loss, often 10–15 kg or more.²^,⁶ This may not be attainable or maintainable for everyone, particularly older adults or those with barriers to physical activity.

Instead, experts suggest that emphasising improvements in quality of life, reducing complications, and supporting individualised, sustainable changes may be more appropriate than chasing remission as an all-or-nothing goal.¹^,⁶

What about diet?

At the heart of this journey is food, not restrictive, joyless eating, but balanced, varied, and nourishing meals that support both metabolic health and quality of life.³ Rather than eliminating entire food groups, many experts now encourage a more inclusive approach, drawing on the strengths of all five food groups in a sustainable way.¹

Food choices play a central role in diabetes management and potential remission. But there’s no single “diabetes diet”. Rather, flexibility, variety, and a focus on whole, minimally processed foods tends to lead to better long-term outcomes.¹

Managing expectations, supporting health

It’s important to frame remission as one potential outcome, not the only marker of success.¹ Many people living with type 2 diabetes never reach remission but still dramatically improve their health through better eating, more movement, and consistent care.

There is also growing recognition that metabolic health involves more than blood glucose. Lipid levels, blood pressure, inflammation, sleep, mental wellbeing, and weight all contribute to overall health and diabetes outcomes.⁶ Improvements in any of these areas, regardless of whether full remission is achieved, can enhance quality of life and reduce the risk of complications.⁶

Healthcare professionals now emphasise a whole-person approach, where goals are individualised and progress is measured in many ways, not just numbers on a lab report.¹

Why blood glucose management is the most important goal

While the idea of remission is motivating for some, it’s critical to remember that managing blood glucose within target ranges is the cornerstone of long-term diabetes care and often a far more realistic and sustainable goal than remission.⁶

Keeping blood glucose levels in target reduces the risk of both short- and long-term complications, including cardiovascular disease, kidney disease, vision loss, nerve damage, and more.⁶ These complications typically result from years of elevated blood glucose levels.⁶ That’s why steady, ongoing management even without the label of “remission” is so valuable.

Small improvements matter

One of the encouraging truths about type 2 diabetes is that every bit of improvement counts. Research shows that for every 1% reduction in HbA1c, the risk of major diabetes-related complications drops significantly, by as much as 21% for diabetes-related deaths, 14% for heart attacks, and 37% for microvascular complications.⁶ If a clients HbA1c moves from 8.5% to 7.5%, they are still making a real difference in their long-term health.

Individualised targets

Blood glucose targets aren’t the same for everyone. Factors like age, other medical conditions, medications, and risk of hypoglycaemia all influence what’s realistic and safe,⁶ A younger person newly diagnosed may aim for tighter control, while an older adult may need more flexible targets to prevent hypoglycaemia.⁶

Working with your client to set a personalised target, and then focusing on staying within that range, can empower them to improve their health without feeling pressured to achieve perfection.

Daily management builds confidence and control

Unlike remission, which may require significant and sometimes unsustainable interventions, managing blood glucose day-to-day is a learnable skill. Over time, understanding how food, movement, stress, and sleep affect their body, your client can increase confidence and reduce diabetes-related distress.³

A note of encouragement

Whether remission is the goal or not, adopting a more balanced, nourishing approach to eating benefits everyone.¹ The aim isn’t perfection, but progress, eating a little better, moving a bit more, and showing compassion along the way.

For some, remission may be achievable. For others, stable and consistent management is the most realistic and sustainable path and it’s just as valuable. The emphasis should always be that remission is never the only “successful” outcome.¹⁶

The most important goal is living well, with a lifestyle that supports physical, emotional, and social wellbeing. With the right support, education, and care, every person with diabetes can make meaningful progress toward better health.

References

1. Diabetes Australia. (2021). Type 2 diabetes remission position statement. https://www.diabetesaustralia.com.au/wp-content/uploads/DA-Position-Statement-Type-2-Diabetes-Remission.pdf
2. Lean, M. E. J., Leslie, W. S., Barnes, A. C., et al. (2019). Durability of a primary care–led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. The Lancet Diabetes & Endocrinology, 7(5), 344–355. https://doi.org/10.1016/S2213-8587(19)30068-3
3. Hallberg, S. J., McKenzie, A. L., Williams, P. T., et al. (2018). Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: An open-label, non-randomized, controlled study. Diabetes Therapy, 9(2), 583–612. https://doi.org/10.1007/s13300-018-0373-9
4. Leslie, W. S., Ford, I., Hollingsworth, K. G., et al. (2023). Sustained diabetes remission through diet only: 5-year data from the DiRECT trial. The Lancet Diabetes & Endocrinology. https://doi.org/10.1016/S2213-8587(23)00094-6
5. Sattar, N., & Gill, J. M. R. (2022). Type 2 diabetes remission: Might weight loss be more important than dietary macronutrient composition? Diabetologia, 65(3), 469–479. https://doi.org/10.1007/s00125-021-05612-2
6. American Diabetes Association. (2023). Standards of medical care in diabetes—2023. Diabetes Care, 46(Supplement 1), S1–S291. https://doi.org/10.2337/dc23-Sint

By Robbie Tyson, Credentialled Diabetes Educator, Accredited Practising Dietitian