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Experts Establish International Criteria for Type 2 Diabetes Remission

Man with diabetes

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Key Takeaways

  • Experts have determined that people with type 2 diabetes who are medication-free for three months and have a hemoglobin A1C lower than 6.5% are considered in remission.
  • People can remain in remission for years and be medication-free, but they still need to be monitored by a healthcare provider.

Diabetes is typically thought of as a chronic condition. But now, experts are saying this may not be the case—people with type 2 diabetes can go into "remission."

The Endocrine Society, the European Association for the Study of Diabetes, Diabetes UK, and the American Diabetes Association combined forces to release guidelines around the term. According to their statement, people with type 2 diabetes should be considered in remission after sustaining normal blood sugar levels for three months or more.

The August report was published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

“When patients are diagnosed with diabetes, they are often told that they have a chronic illness,”  Anya Rosen, MS, RD, LD, CPT, a registered dietitian, tells Verywell. “This makes many people feel unmotivated to change their diet and lifestyle. As a result, their health can continue to deteriorate.”

This new term can help motivate people to take appropriate steps to manage their diabetes, knowing that the possibility of remission—and living medication-free—exists. 

What Is Type 2 Diabetes?

Type 2 diabetes can be a result of both genetics and lifestyle choices, and it affects the way the body uses glucose (carbohydrates) for energy. If glucose is not being transported into your cells, it can remain in the bloodstream and can result in outcomes like eye damage, heart disease, and kidney disease. This condition is different from type 1 diabetes, which occurs due to an autoimmune disorder that prevents the body from producing enough insulin that helps metabolize glucose. A hemoglobin A1C (HbA1C) blood test is typically used to diagnose type 2 diabetes. In order to be diagnosed with type 1 diabetes, HbA1c levels must be 6.5% or higher. 

“If more health professionals emphasized the possibility of remission, millions of people might understand that they have the power to change their health through nutrition alone,” Rosen says.

Once people receive a type 2 diabetes diagnosis, along with possibly being prescribed medication to help the body use glucose, they are often told to include certain lifestyle practices to help manage the condition, including:

  • Maintaining a healthy weight
  • Participating in physical activity 
  • Choosing fiber-rich foods and limiting concentrated sweets

What Is Diabetes Remission?

Type 2 diabetes management has improved over the years, thanks to newer medications and updated practices. Now, experts saw a need for updating diabetes terminology.

International experts joined forces to provide updated recommendations for the most appropriate definitions of terms used when discussing blood glucose measurements and type 2 diabetes status. 

While the terms resolution, reversal, remission, and cure have all been used to describe positive outcomes in diseases, these experts landed on the word "remission" for several reasons. 

Diabetes improvement may not be permanent, and the term remission does not imply a permanent cure. Just like in the case of cancer, type 2 diabetes can reappear, especially due to certain lifestyle practices. 

In contrast, saying that diabetes is resolved implies that no diabetes will be present ever again. Unfortunately, there is no cure for diabetes, and even if a person is deemed to be in remission, they can still have elevated blood sugars in the future and are at risk for diabetes-related outcomes like kidney disease.

How Is Remission Diagnosed? 

In order to be considered in remission, a person needs to be off of any diabetes-managing medication for at least three months and their hemoglobin A1c (HbA1c) must be less than 6.5% consistently.

Individual's A1c levels should be tested annually to confirm they're still in remission.

In certain circumstances, when a doctor determines the A1c value cannot be used, a fasting plasma glucose of less than 126 mg/dL as calculated from continuous glucose monitoring values can be used to determine remission.

Being in remission doesn’t give a person a hall-pass from getting routine check-ups. Patients should still undergo retinal screenings, foot health evaluations, kidney function testing, and blood pressure evaluations to ensure they're not at-risk for diabetes-related complications. 

What This Means For You

If you are diagnosed with type 2 diabetes, your condition can be considered in remission if you have been off of glucose-managing medication for three months and your hemoglobin A1c (HbA1c) value remains less than 6.5%. Even if you are in remission, you should continue to be followed by your healthcare provider to ensure you are not at risk for any diabetes-related complications. 

Lifestyle Changes to Support Remission

While there is no silver bullet for achieving diabetes remission, there are some steps you can take to improve your chances. 

One study found that, among people with diabetes, losing as little as 10% of body weight during the first 5 years of receiving a diagnosis led to a 77% chance of going into remission.

Weight loss appears to be the strongest predictor for diabetes remission, regardless of how you lose the weight. Various diets can also help, including a lower-carb Mediterranean diet.

To lose weight in a healthy way, you should avoid crash diets. Instead, seek the support of a registered dietitian because specific nutritional needs can vary from person to person. 

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