What are the current rates of Type 2 Diabetes (T2D) remission?

From the Guidelines

Current rates of Type 2 Diabetes (T2D) remission can be as high as 54% with total diet replacement (TDR) interventions, as seen in a recent study published in Diabetologia in 2022 1.

Key Findings

• The study found that TDR leads to a large increase in T2D remission by a median of 54% from baseline, when compared with standard care, with a high certainty of evidence.
• Other dietary interventions, such as meal replacement and Mediterranean diet, may also lead to T2D remission, but with lower success rates and moderate to low certainty of evidence.
• The evidence suggests that weight loss is a key contributor to T2D remission, with every 1 kg of weight loss associated with a 7% higher chance of remission at 5 years 1.

Intervention Approaches

• Total diet replacement (TDR) appears to be the most effective intervention for achieving T2D remission, with a median remission rate of 54% at 1 year.
• Other dietary interventions, such as meal replacement and Mediterranean diet, may also be effective, but with lower success rates.
• Conventional lifestyle modifications and medication-based approaches may yield lower remission rates, but can still be effective in combination with lifestyle changes.

Definition of Remission

• Remission is defined as maintaining normal blood glucose levels (HbA1c <6.5% or <48 mmol/mol) without diabetes medications for at least three months.
• Early intervention is crucial, as patients with shorter diabetes duration (less than 6 years) and those not requiring insulin have significantly better chances of achieving remission.

Underlying Mechanism

• The underlying mechanism involves reducing fat in the liver and pancreas, restoring beta cell function and insulin sensitivity.
• Maintaining weight loss is essential for sustaining remission long-term.

Recent Studies

• A recent study published in Diabetologia in 2022 found that TDR can lead to a large increase in T2D remission, with a median remission rate of 54% at 1 year 1.
• Another study published in the same journal in 2022 found that weight loss is a key contributor to T2D remission, with every 1 kg of weight loss associated with a 7% higher chance of remission at 5 years 1.

From the Research

Type 2 Diabetes Remission Rates

The current rates of Type 2 Diabetes (T2D) remission vary depending on the study and the criteria used to define remission. Here are some key findings:

• A study published in 2024 found that with substantial intentional weight loss, almost nine in ten people with type 2 diabetes can reduce their HbA1c level below the diagnostic criterion (48 mmol/mol [6.5%]) without glucose-lowering medications 2.
• A 2012 study reported that an intensive lifestyle intervention was associated with a greater likelihood of partial remission of type 2 diabetes, with 11.5% of participants achieving remission at 1 year and 7.3% at 4 years 3.
• A 2018 study found that a primary care-led weight management program resulted in 46% of participants achieving remission of type 2 diabetes at 12 months, defined as an HbA1c level of less than 6.5% (<48 mmol/mol) after at least 2 months off all antidiabetic medications 4.
• A 2025 systematic review and meta-regression analysis reported that the pooled mean proportion of participants with complete remission 1 year after a bodyweight loss intervention was 0.7% for those with bodyweight loss less than 10%, 49.6% for those with bodyweight loss of 20-29%, and 79.1% for those with bodyweight loss of 30% or greater 5.
• A 2014 study estimated the incidence of remission in adults with type 2 diabetes and found that the 7-year cumulative incidence of partial, complete, or prolonged remission was 1.47%, 0.14%, and 0.007%, respectively 6.

Factors Associated with Remission

Several factors are associated with an increased likelihood of remission, including:

• Substantial intentional weight loss 2, 5
• Intensive lifestyle intervention 3
• Primary care-led weight management program 4
• Short duration of type 2 diabetes 2, 6
• Lower HbA1c level at baseline 2, 6
• No diabetes medication at baseline 6
• Age >65 years 6
• African American race 6

Remission Rates by Bodyweight Loss

The remission rates vary by the degree of bodyweight loss, with higher rates of remission observed with greater weight loss:

• Less than 10% bodyweight loss: 0.7% complete remission, 5.4% partial remission 5
• 10-19% bodyweight loss: no data on complete remission, 48.4% partial remission 5
• 20-29% bodyweight loss: 49.6% complete remission, 69.3% partial remission 5
• 30% or greater bodyweight loss: 79.1% complete remission, 89.5% partial remission 5