Type 2 Diabetes Remission

Understanding Remission

The term ‘remission’ is more familiar in the context of cancer. Remission means the disease is no longer active, but it could return. This is different from a ‘cure’ which means the disease is completely gone. For Type 2 diabetes we are not at the cure stage quite yet.

What is diabetes remission?

Diabetes remission is defined as:

• Having an HbA1c of 6.5% or lower
• Maintaining HbA1c under 6.5% for at least 3 months
• Not taking any glucose lowering medications.

This is definitely a great outcome.

However, keep in mind that being diagnosed with type 2 diabetes is a sign that you have the genes for diabetes. Hence, type 2 diabetes can return if you put on weight, decrease physical activity or even just because you age. Remission is not a permanent fix; it is more like hitting the pause button.

What affects the chance of remission?

Some people are more likely to go into remission than others. This includes:

• Having excess body weight when diagnosed - remission often requires significant weight loss. This is not possible for all people, as some people with type 2 diabetes are not overweight.
• How long you’ve had diabetes – The longer you’ve had type 2 diabetes, the harder it is to go into remission. Over time, the insulin-producing cells in the pancreas can become worn out and not work as well. After many years, some of these cells may not recover enough to make insulin again.

How can you get into diabetes remission?

Weight loss - the key strategy

Weight loss remains one of the most important factors. Losing about 10 -15% of body weight is usually needed. Weight loss helps because it reduces fat around the liver and pancreas. As a result, the body becomes more sensitive to insulin and can use it more effectively.

What can help with weight-loss?

1. Lifestyle changes

Healthy eating and regular physical activity can improve blood glucose levels and overall health. However, most people find it challenging to lose and maintain significant amounts of weight through diet and exercise alone. Strict dieting may be needed to lose 10-15% of your body weight and studies show most people struggle to maintain this style of eating. More sustainable dietary patterns, such as the Mediterranean-style diet, has been shown to improve glucose levels and heart health, even if they do not always lead to full remission.

2. Medications (GLP-1 therapies)

Type 2 diabetes medications such as Ozempic (semaglutide) and Trulicity (dulaglutide) can help with weight loss. They work by:

• Reducing appetite
• Increasing feelings of fullness
• Reducing overall food intake
• Reducing cravings or interest in certain foods

This can often lead to weight loss and improved blood glucose levels. In some people, especially when combined with lifestyle changes, this may help with significant weight loss. However, many people find their appetite increases once they stop these medications and weight gain follows.

3. Weight loss surgery

Weight loss surgery has one of the highest success rates in putting type 2 diabetes into remission. The most effective surgeries for remission are gastric sleeves and gastric bypasses. Weight loss surgery is available to people with type 2 diabetes and a body mass index (BMI) higher than 30.

Remission vs reaching diabetes targets with medication - is one better than the other?

Type 2 diabetes can be managed well in many ways, such as:

• Putting diabetes into remission through weight loss
• Managing diabetes with a combination of medication and lifestyle changes

Current evidence suggests both approaches reduce the risk of diabetes related complications. Hence, it remains unclear whether being in remission provides any extra long-term benefits compared to well-managed diabetes with medications.

So, should remission be the goal?

Remission is a good outcome, but chasing remission at all costs isn’t the best strategy. The best diabetes management strategy for you may be different to another person, but some key goals for everyone are to:

• Keep your blood glucose levels in-target
• Be active every day
• Eat a well-balanced diet
• Have regular check-ups with your healthcare team

These steps can make a meaningful difference to long-term health.