Current research supports the idea that remission of type 2 diabetes is increasingly achievable.
A 2023 study published in Diabetes Care showed that an intensive low-energy total diet replacement program in Australian primary care led to diabetes remission at 1 year in about half of the participants with recently diagnosed type 2 diabetes, with higher remission rates tracking with greater weight loss. Meanwhile, a September 2025 systematic review and meta-analysis in the same journal pooled 18 nonsurgical randomized controlled trials and found that structured interventions, particularly those producing substantial weight loss, consistently achieved clinically meaningful remission rates.
Evidence from other journals points in the same direction.
Deploying modern tools in a structured, evidence-based progression can still be confusing, and it can be labor-intensive and time-consuming to pull off in a primary care setting. GLP-1 receptor agonists, SGLT2 inhibitors, digital coaching programs, structured nutrition therapy, and metabolic surgery referrals are all valid options for glycemic improvement and, in some cases, reversal. But without a clear framework, reactive care can be an “easier” default, rather than remission-oriented care. Hospitalists increasingly see the results on both sides: patients whose early intervention prevented admissions and others whose stalled outpatient management resulted in crises.
What Counts as True Remission?
As remission becomes a more realistic clinical endpoint, precise definitions matter.
“Clinically, diabetes remission is defined as the return of glycemic markers to the nondiabetic range without the continued use of glucose-lowering medications, sustained over time,” said William Hsu, MD, chief medical officer of Los Angeles-based L-Nutra, a longevity science company that offers diabetes remission solutions, and the former vice president of Harvard’s Joslin Diabetes Center. “Most major consensus groups align on an HbA1c of < 6.5% maintained for at least 3 months without glucose-lowering drugs.”
Eve Elizabeth Pennie, MD, an epidemiologist with the Texas Department of State Health Services in Austin, Texas, provided some additional data.
A fasting glucose of < 126 mg/dL; continuous glucose monitoring (CGM) or an oral glucose tolerance test may be used as alternatives to A1c when A1c values are not available, Pennie said. “Diabetes remission indicates sustained normoglycemia with minimal use of pharmacologic agents; however, underlying cardiometabolic risks persist, and continued surveillance for complications will occur.”
Finally, Hsu emphasized that a temporary glycemic improvement is not sufficient to be considered remission.
“A transient improvement in A1c while insulin resistance, visceral adiposity, and postprandial excursions remain elevated is only a temporary fix and not considered remission in our program. We use a root-cause metabolic lens, not just an A1c lens.”
Building a Remission-Oriented Pathway
Because early disease is the most reversible, timing is central to successful remission strategies.
“The greatest opportunity for achieving diabetes remission is through early, weight-centered interventions,” Pennie said.
The majority of clinicians start metformin when appropriate and pair it with a GLP-1 receptor agonist at the earliest time possible to enhance weight loss and improve cardiometabolic outcomes, she said. “The addition of an SGLT2 inhibitor is indicated in those who have evidence of heart failure or CKD [chronic kidney disease]. All newly diagnosed patients should begin an intensive lifestyle intervention and digital coaching immediately upon their diagnosis.”
Hsu said the issue is more one of addressing underlying metabolic dysfunction as opposed to simply suppressing glucose.
“The so-called ‘standard care’ focuses on returning biomarkers to below a specific level at the cost of polypharmacy and patient burden. The reality is when you stop these meds, glucose goes back up,” he said.
Thus, he describes early metabolic unloading as foundational.
“Newly diagnosed patients have the greatest potential to reverse metabolic dysfunction when the liver and pancreas are given early relief from glucose and insulin burden.”
Many studies — including the DiRECT trial, a primary care-led weight management program for diabetes, and the 2023 study published in Diabetes Care — focused on intensive lifestyle intervention. They would treat remission as a structured process, not an incidental outcome, schedule periodic reassessments, adjust therapy promptly, and integrate nutrition and digital supports throughout the early disease period.
If lifestyle management fails to achieve sustainable progress, both doctors said that surgery remains one of the most reliable ways to achieve truly durable remission when used appropriately. However, Hsu said that surgery is often misunderstood as the only “serious” option when, in reality, many patients can experience “profound” metabolic improvements through structured, sustainable metabolic rehabilitation before ever considering an invasive intervention.
“For most people, strict daily dietary overhauls are simply not achievable or sustainable. When those attempts fail or when complications are pressing, surgery is positioned as the next escalation,” Hsu said. “This overlooks the fact that structured, periodic metabolic interventions delivered as part of a comprehensive chronic disease program can meaningfully reduce hepatic fat, improve insulin sensitivity, and shift metabolic trajectories without requiring daily perfection or lifelong restriction.”
He cited L-Nutra’s diabetes remission solution as an example of the kind of intervention that could produce such results.
When it does come to surgery, this is another case where precise definitions matter, Pennie said.
“Referral is appropriate for patients with a BMI ≥ 40, or ≥ 35 with uncontrolled diabetes, and selected candidates may be referred with a BMI of 30-34.9 when other treatments fail to achieve adequate glycemic control,” Pennie said. For these patients, she said, “Surgical interventions are among the most effective methods for achieving durable remission and should be considered in earlier stages of treatment planning.”
The Characteristics of Patients in Remission
With his extensive experience at Harvard’s diabetes center as well as in working with the program L-Nutra offers, Hsu said that patients with successful remission trajectories share key characteristics.
“These patients receive early, aggressive metabolic intervention and interventions that occur earlier in life,” Hsu said. “The interventions include structured low-glycemic nutritional therapy, and they have regular touchpoints with a clinical team.”
Hsu said that for these patients, their CGM is more than just a source for passively monitoring readings; it’s a tool and a learning device that actively shapes activities like eating and exercise.
“They use CGM to understand food responses and adjust their behavior,” he said.
The patients who have successful remission trajectories are not only dropping pounds on the scale but also seeing a consistent reduction in visceral fat, according to Hsu. Then, they are gradually tapering their medications under the supervision of their clinical team — the close supervision enables them to avoid the metabolic crises and side effects discussed previously.
“These patients also have stable circadian eating patterns and reduced postprandial glucose variability,” Hsu said. “All in all, remission emerges when glucose, insulin, and behavior converge, not just when a medication suppresses appetite or glucose production.”
Hsu reported being employed by L-Nutra, and as such, having a financial relationship with the company. He reported being a venture partner at 618 Ventures, an early-stage venture capital firm backing companies transforming the future of health. Pennie reported having no disclosures.
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