T2D Remission Possible, but Better Implementation Needed

 Being diagnosed with type 2 diabetes (T2D) can be a life-changing event but doesn’t necessarily mean a lifetime of taking medications to manage blood sugar levels, suggests evidence presented at the Diabetes Canada and Canadian Society of Endocrinology and Metabolism (CSEM) Professional Conference 2025.

Various interventions have the potential to send T2D into remission, defined by Diabetes Canada as a return to prediabetes or normal glucose concentrations without the use of antihyperglycemic medications for at least 3 months.

Although many of these T2D remission interventions have been tested for effectiveness in randomized controlled trials (RCTs), more work is needed to understand how to implement these often-intensive strategies in the real world, said Megan Racey, PhD, research coordinator in the School of Nursing at McMaster University in Hamilton, Ontario.

Racey is the corresponding author of a systematic review and meta-analysis published in Diabetes Care, the findings of which she presented at the conference.

“Research can often focus on the individual’s capacity and capabilities to do these [remission] programs,” she pointed out. “However, we know that there are structures and systems in place that lead to T2D in the first place, which aren’t necessarily supported by current research.”

Drug and Behavioral Interventions Effective

For the meta-analysis, Racey and her colleagues reviewed 18 RCTs from 11 countries published between 2008 and 2025. These studies investigated the impact of pharmacologic and nonpharmacologic interventions, such as behavior, lifestyle, or meal-replacement strategies, on T2D remission. Surgical interventions were excluded from the analysis.

Study durations ranged from 12 weeks to 18 months, with a total of almost 8000 participants aged 42-59 years who had been diagnosed with T2D within 7 years prior to the start of the study.

Most participants were not taking insulin, although they may have been using other diabetes medications such as metformin, insulin, GLP-1s, and SGLT2 inhibitors. Medications sometimes were combined with lifestyle changes and delivered mostly in clinical settings by healthcare professionals. Only one study examined medication on its own.

Overall, the analysis showed that patients in a pharmacologic intervention group were 1.75 times more likely to achieve diabetes remission than those in a control group. In the nonpharmacologic RCTs, the likelihood of achieving diabetes remission was 5.80 times greater for those in the intervention group than for those in the control group.

“Both intervention types demonstrated other benefits,” said Racey, “such as significant reductions in HbA1c and body weight, improved quality of life, and lower risk for hypoglycemia and diabetes relapse.”

While the risk ratios were higher for nonpharmacologic studies, remission rates declined over time, especially for nonpharmacologic interventions. “This [finding] highlights the challenge of sustaining behavior change and the importance of multimodal strategies that include medications,” said Racey.

Patient-Centered Approach

When researchers looked at the specific components included in the interventions, they found that “diabetes remission really requires an interdisciplinary team,” said Racey. “All these studies use a range of doctors, healthcare professionals, nurses, dietitians, and other research staff.”

Also common among the studies was a tailored approach based on patient preferences, values, and needs, which “is required to ensure long-lasting behavior changes,” she said. Tailoring included things such as addressing individual barriers, considering cultural and ethnic factors, and helping participants set and meet goals.

While progress has been made in understanding the best practices for helping patients achieve T2D remission, more research is needed, she said. For example, there are questions about which people might benefit most from certain interventions, and given the lack of information in RCTs about patient or provider satisfaction, “it’s unclear if these programs will work for everyone.”

Furthermore, T2D “tends to impact people who are more vulnerable to social and economic barriers,” she said. “So, the [diabetes remission] program really needs to be offered in an accessible and equitable way.”

Prevention Programs Offer Insights

Racey suggested that diabetes prevention programs (DPPs) may offer insight into how to structure remission programs equitably. “We can learn…how they’re breaking down barriers to reach those people who need the interventions most.”

DPPs, which focus on healthy eating and physical activity, “have demonstrated great success at reducing the progression of prediabetes to T2D without negative side effects,” said Mary Jung, PhD, professor in the School of Health and Exercise Sciences at the University of British Columbia in Kelowna, British Columbia.

These programs are often delivered in clinical settings, however, which can make them inaccessible to some segments of the population. “We believe that more interventions must be delivered in community settings,” said Jung, who presented results from her team’s research on a 4-week community-based DPP. They found that changes in clinical outcomes were comparable to those achieved in more time-intensive and costly programs.

Community-based DPPs “have the potential to reach those most in need without the cost,” she added.

This meta-analysis research was supported by the McMaster Evidence Review and Synthesis Team and the Canadian Institutes of Health Research Knowledge Mobilization Grant. Racey and Jung reported having no relevant financial relationships.

https://www.medscape.com/viewarticle/t2d-remission-possible-better-implementation-needed-2025a1000y41