Type 2 diabetes remission: what it means and how it is achieved

Diabetes UK defines type 2 diabetes remission as your long-term blood sugars falling below the diabetes level and staying there for at least three months without the need for glucose-lowering medication. In medical terms that means an HbA1c below 48 mmol/mol or 6.5%, a definition it says was agreed by experts from Diabetes UK, the American Diabetes Association and the European Association for the Study of Diabetes.

The charity is careful with language. Many people say "reversing" their diabetes, but Diabetes UK and the NHS say remission, because the diabetes has not gone away completely and blood sugar can rise again. Being in remission stops the diabetes doing new damage, but there may be harm from earlier years of high blood sugar, which is why eye screening and kidney checks continue.

Diabetes UK says the causes of type 2 diabetes are multiple and complex, but in many cases it is linked to a build-up of fat inside the liver and pancreas. The pancreas makes insulin, which lowers blood sugar, and the liver steadies blood sugar by storing and releasing glucose. Fat in these organs can stop them working properly, and losing weight can reduce that fat and help them manage blood sugar again.

There is no easy way to know how much fat is in your liver and pancreas, and Diabetes UK points out that you cannot tell by someone's weight or body size, since people differ in how much fat they can store safely. It also admits that it does not know enough to say weight loss will lead to remission for everyone, and that some people have been unable to get blood sugar below the diabetes range without medication however hard they have tried.

Diabetes UK says remission is more likely the sooner you try after diagnosis, and that people living with overweight or obesity are more likely to go into remission if they lose around 15 kg (about 2 stone 5 pounds) quickly and safely following diagnosis. It says you can go in and out of remission, that some people stay in remission for years, and that others see sugars rise again after a time, particularly if they regain weight.

NHS England describes the research behind its programme. In the DiRECT trial, funded by Diabetes UK, almost half of those who followed a low calorie diet achieved remission after one year. A quarter of participants lost 15 kg or more, and of those, 86% put their diabetes into remission. A second trial, DROPLET, showed similar weight loss in people with obesity. For the programme itself, early outcome data cited by NHS England found that of those who completed it and had two HbA1c measurements recorded, 32% had put their diabetes into remission, with an average weight loss of almost 16 kg.

These figures come from trials and early service data, so they describe groups rather than predict what will happen to one person.

NHS England describes the programme as a joint initiative with Diabetes UK, available to eligible people in England, providing a low calorie, total diet replacement treatment for people with type 2 diabetes and obesity or overweight. Participants are offered products such as soups and shakes providing 800 to 900 kilocalories a day for 12 weeks, replacing all normal meals during that period. They then receive support and monitoring for 12 months, including help to reintroduce food, with a choice of a coach in person or digitally. It is fully funded by the NHS, and the local GP practice supports participants, for example by changing medicines.

Eligibility rules include a type 2 diabetes diagnosis within the last 6 years and a BMI over 27 kg/m2 for people from White ethnic groups or over 25 kg/m2 for people from Black, Asian and other ethnic groups. NHS England says the programme will not suit everyone, that people should discuss their circumstances with their GP or diabetes team, and that those not eligible may have other local services or, with obesity and diabetes or hypertension, may be eligible for the NHS Digital Weight Management Programme.

Because a diet of this kind changes how much glucose-lowering and blood pressure medicine a person needs, it is meant to be undertaken with healthcare supervision rather than alone. Do not stop or change diabetes medicines without advice from your team.

Diabetes UK explains that diabetes eye screening and checks for kidney disease are the ways to look for diabetes-related problems that may predate remission. Your doctor or diabetes nurse will monitor your blood sugar levels so action can be taken if they rise again.

Benefits are not limited to a blood test number. According to Diabetes UK, remission can reduce the chance of complications such as heart attacks, strokes and sight loss, may help lower blood pressure, cholesterol and weight, and can mean fewer medicines, more energy and better sleep. It adds that any improvement in blood sugar, blood pressure and cholesterol reduces risk, whether or not you reach remission.

Diabetes UK recognises that trying for remission and staying in it can be mentally and emotionally tough because it means big, lasting changes. Its advice includes managing expectations, since remission is not a certainty and a rise in blood sugar can feel demotivating, and reminding yourself that no effort is wasted because any lowering of blood sugar and weight benefits health.

It suggests setting small goals, rewarding progress, reflecting on how far you have come and being kind to yourself on harder days. The largest remission study showed that people supported to make long-term changes to diet and activity had a better chance of remission, which is why the NHS programme includes dietitians, health psychologists and exercise experts. Friends, family and support groups can also help, and your healthcare team is the best starting point for support.

Diabetes UK says staying in remission can be hard, and that people who regain weight may come out of remission. This is not a personal failing. A return of raised HbA1c is a signal to speak to your GP or diabetes nurse, who can review your treatment and support options, including restarting medicine if needed.

People often ask about other types of diabetes. Diabetes UK has a separate page on reversing other types, and remission as defined here applies to type 2 diabetes.

In England the NHS offers the Path to Remission Programme, structured education, dietitian support and routine HbA1c monitoring. Eligibility is set nationally, and your practice can tell you what is available locally.

Private routes include self-funded dietitians, weight management clinics and endocrinologists. If you pursue them, tell your NHS diabetes team, because medicine doses may need adjusting as weight falls and blood sugar changes. Be cautious about any programme that promises a cure or advises stopping prescribed medicines without supervision.