Brittany Poulson, MDA, RDN, CDCES, is a registered dietitian and certified diabetes care and education specialist.
Do-Eun Lee, MD, has been practicing medicine for more than 20 years, and specializes in diabetes, thyroid issues and general endocrinology. She currently has a private practice in Lafayette, CA.
Type 2 diabetes remission occurs when blood glucose (sugar) levels remain below the range that defines diabetes. However, remission does not mean a cure.
Someone with type 2 diabetes that’s in remission can return to a state of hyperglycemia (high blood glucose levels) and type 2 diabetes, especially if weight is regained or unhealthy lifestyle habits return.
This article discusses remission in type 2 diabetes, the factors that lead to remission, and the steps you can take to stay in remission.
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Type 2 diabetes is considered to be in remission when blood glucose levels have been in the normal (nondiabetic) range for three months or more without the use of glucose-lowering medication.
Your healthcare provider may use an A1C test (average blood glucose level over the past three months) as the criterion for remission. Alternatively, they may use fasting blood glucose levels or check your 24-hour average glucose levels provided by a continuous glucose monitor.
Most experts agree that "remission" is the appropriate term for a return to normal blood glucose levels.
The term "cure" is not used for a return to normal levels because the improvement may not be permanent. There is always a chance that high blood glucose levels can return.
Someone with type 2 diabetes in remission may still require regular checkups and support to prevent or delay a relapse of high blood glucose levels.
People with type 2 diabetes who have undergone metabolic (bariatric) surgery are more likely to achieve diabetes remission than people who haven’t had surgery. However, remission may not be permanent, with over half of those with remission at two years after surgery having recurrence of diabetes within 15 years.
Weight loss, with or without the help of metabolic surgery, is one of the main characteristics seen in people who have achieved diabetes remission. Significant and maintained weight loss of at least 22 pounds (10 kilograms) is a significant factor in diabetes remission in several studies. People with lower amounts of weight loss may be less likely to attain type 2 diabetes remission.
Other characteristics commonly seen in people who have achieved type 2 diabetes remission include not taking diabetes medication or using less diabetes medication, having a short duration of diabetes, and having a lower initial A1C level.
Diet and physical activity can help you maintain a healthy weight with diabetes.
Though there is no official diabetes diet, there are general dietary principles that can be followed to help you maintain a healthy weight with diabetes.
A diet with a variety of vegetables, whole fruit, whole grains, lean protein, low-fat dairy, and heart-healthy fats is a good place to start. Limit the amount of highly processed foods and added sugars in your diet, as well.
Some experts recommend the diabetes plate method. This is a simple guide to helping you plan out your meals.
Using a 9-inch plate, fill half of your plate with non-starchy vegetables (such as leafy greens, broccoli, carrots, peppers, summer squash), one-fourth of your plate with protein foods (lean meat, fish, beans, lentils), and the remaining one-fourth with carbohydrate foods (potatoes, rice, pasta, bread, preferring whole grains).
The main beverage to consume should be water. Avoid or limit sugar-sweetened drinks.
Physical activity is another step toward maintaining a manageable weight and better health. It’s recommended to get at least 150 minutes of moderate-intensity physical activity each week. This could be walking, running, swimming, dancing, biking, playing a sport, or doing housework or yard work.
Choose an activity you enjoy, as you’ll be more likely to stick with it. Additionally, do strength-training exercises two or more days a week. This can be done with hand weights, elastic bands, weight machines, or even your body weight.
Maintaining weight loss, enjoying a healthy diet, and being physically active can help you stay in diabetes remission by managing your blood glucose levels and benefiting your overall health.
Seeing your healthcare provider regularly is still important, as a medical professional can help detect if your diabetes symptoms are returning. Your healthcare provider can guide you in creating a maintenance plan to stay in diabetes remission.
If you want to get your diabetes under control and lower your blood glucose levels, talk with your healthcare provider. They can provide a treatment plan to help you lower your blood glucose levels. They can also help determine if you are a potential candidate for metabolic surgery.
By following your diabetes treatment plan, following a healthy diet, and getting enough exercise, you might achieve full or partial diabetes remission.
Study results have varied, but a 2021 study suggested that nearly 5% of people with type 2 diabetes achieve remission. People who have metabolic surgery have a higher remission rate than those who do not have surgery.
A 2014 Swedish study showed a 72% remission rate two years after metabolic surgery vs. 16% of people who didn't have surgery. However, remission rates declined over time. Fifteen years after surgery only 30% of surgery patients and 6.5% of people in the control group remained in diabetes remission.
More long-term studies are needed to investigate type 2 diabetes remission rates over time, as well as the risk of complications from diabetes after remission.
Type 2 diabetes remission is when blood glucose levels are below the diabetes range for at least three months without using antidiabetic (blood glucose lowering) medications.
Factors associated with diabetes remission include metabolic surgery, significant weight loss, not using diabetes medications, a shorter duration of diabetes, and a lower baseline A1C level.
Maintaining weight loss and a healthy lifestyle with a nutritious diet and regular physical activity can help you stay in remission. Regular checkups with a healthcare provider are still important to ensure continued diabetes remission and can help prevent or delay a relapse.
Type 2 diabetes remission is possible, but there are numerous factors that play a role in it. Even if diabetes remission is achieved, dedication to a healthy lifestyle is critical to prevent or delay a relapse. With the support of your healthcare provider and consistency in healthy habits, you can start on the path to successful diabetes management.
Type 2 diabetes remission is not considered to be a cure or to be permanent. Someone with type 2 diabetes in remission can return to a state of hyperglycemia (high blood glucose levels) and type 2 diabetes, especially if weight is regained or unhealthy lifestyle habits return.
Type 2 diabetes is considered to be in remission when your blood glucose levels have been in the normal, nondiabetic range for three months or more without the use of antidiabetic (glucose-lowering) medication. This is typically observed via A1C tests, fasting blood glucose levels, or a 24-hour blood glucose average from a continuous glucose monitor.
Study results have varied, but a 2021 study reported that nearly 5% of people with type 2 diabetes achieve remission. People who have undergone metabolic surgery have a higher likelihood of remission compared to those who have not. However, remission rates tend to decline over time.
Riddle MC, Cefalu WT, Evans PH, et al. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care. 2021;44(10):2438-2444. doi:10.2337/dci21-0034
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Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297-2304. doi:10.1001/jama.2014.5988
Taheri S. Defining type 2 diabetes remission: KISS goodbye to confusion?. Lancet Diabetes Endocrinol. 2021;9(12):806-808. doi:10.1016/S2213-8587(21)00290-4
Karter AJ, Nundy S, Parker MM, Moffet HH, Huang ES. Incidence of remission in adults with type 2 diabetes: the diabetes & aging study. Diabetes Care. 2014;37(12):3188-3195. doi:10.2337/dc14-0874
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Centers for Disease Control and Prevention. Diabetes: get active!
National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes diet, eating & physical activity.
Captieux M, Fleetwood K, Kennon B, et al. Epidemiology of type 2 diabetes remission in Scotland in 2019: a cross-sectional population-based study. PLoS Med. 2021;18(11):e1003828. doi:10.1371/journal.pmed.1003828
Brittany Poulson, MDA, RDN, CDCES, is a registered dietitian and certified diabetes care and education specialist.
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