What Is Type 2 Diabetes Remission?
According to the American Diabetes Association, type 2 diabetes remission means lowering your A1C below 6.5% for at least three months without taking glucose-lowering medication.
That’s different from having well-controlled diabetes. For many adults with type 2 diabetes, an A1C below 7% is a common treatment goal. And reaching that goal with medication is still a successful outcome for your health.
I think of these as two different goals in a treatment plan: first, get high blood sugar under control using the tools you and your doctor agree upon. Then, if reducing medication is important to you and medically appropriate, remission may be another goal to pursue.
What is the difference between controlled diabetes and remission?
Controlled type 2 diabetes
A1C: often below 7%
Medication: with or without
Goal: control hyperglycemia and reduce complications
Type 2 diabetes remission
A1C: below 6.5% for at least three months
Medication: no glucose-lowering medication
Goal: maintain glucose below the diabetes diagnostic threshold without medication
To be clear, these don’t compete with each other because progress can build on each other.
Also, an A1c of 6.9% on metformin can be good diabetes control. It just doesn’t meet the technical definition of remission.
Why call it remission instead of reversal?
When debating a term for this treatment goal, the consensus group considered terms including diabetes reversal, resolution, and cure.
They chose remission for two main reasons:
Your blood sugar can improve enough that you no longer meet the diagnostic criteria for diabetes without glucose-lowering medication.
The diabetes can return. The underlying susceptibility remains, so “cure” overstates what we know.
That said, I don’t think people are wrong when they tell me they want to “reverse” their diabetes. That tells me they want normal blood sugar and less medication, regardless of what they call it. Clinically, remission is simply a more accurate way to describe that outcome.
Do you have to lose weight to put type 2 diabetes into remission?
No, weight loss isn't required by the definition, but for people carrying excess weight, research suggests that substantial weight loss can be one of the most powerful tools for achieving remission. The DiRECT trial, for example, is one of the landmark studies of lifestyle-induced diabetes remission. It found a significant relationship between the amount of weight participants lost and their likelihood of achieving remission.
Weight loss itself, however, isn't part of the definition of remission. You don't have to lose a certain number of pounds or percentage of your body weight to qualify. What matters for remission is whether you can maintain an A1C below 6.5% without glucose-lowering medication.
How I think about remission as a primary care doctor
Treating type 2 diabetes happens in stages:
Control the high blood sugar. If your A1C is above your treatment target, the first goal is to get your blood sugar under control safely. Lifestyle changes, diet, and medication are all useful tools.
Decide whether you want to pursue remission. Once your blood sugar is controlled, you can decide whether reducing medication and pursuing remission is an appropriate goal. We can then determine whether that's realistic in your case and what would need to change to pursue it safely.
Keep working on your health. Up to this point we were focused on your blood sugar numbers, but that doesn’t tell me everything I need to know about your overall health. Strength, body composition, endurance, blood pressure, sleep, and other factors also matter.
These aren't competing goals. Good diabetes control is a successful outcome whether or not you ultimately pursue remission. It’s simply another treatment goal that some people may choose to pursue. It’s OK to take medications, too. What matters most is that you are clear on your goals and you have a strategy to get you there.
Should you try to get off your diabetes medication?
Not necessarily. The first question I'd ask is why you want to stop it. Diabetes medications are very effective at lowering glucose and, depending on the medication, provide helpful heart and kidney benefits. Don't stop medication simply to see whether you qualify for remission, or because you read an article that said metformin is bad.
But if reducing medication is important to you, tell your healthcare provider. That's a legitimate treatment preference, and it can often be incorporated into your plan while your blood sugar and medications are monitored safely.
Want help with your type 2 diabetes?
If you're trying to lower your blood sugar, reduce medication, or determine whether remission is realistic, book a free call and we'll talk about what you're trying to accomplish and whether I can help.
Prefer to call? (406) 546-2164
FAQ
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Below 6.5% for at least three months without glucose-lowering medication.
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Not according to the current consensus definition if metformin is being used to lower glucose.
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Yes. Remission isn't considered a cure, and continued monitoring is recommended.
References
Riddle MC, Cefalu WT, Evans PH, et al. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care. 2021;44(10):2438–2444.
American Diabetes Association Professional Practice Committee. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes—2026. Diabetes Care.
Lean MEJ, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet.
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