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Diabetes

Type 2 diabetes: what remission means and how often it lasts

Act nowDo not stop diabetes or blood pressure medicines, or start a very low calorie diet, without your doctor. US guidance says such diets should be given only to carefully chosen people by trained staff with close monitoring, because of risks such as heart rhythm problems. When a weight-loss drug such as semaglutide or tirzepatide is added, it says sulfonylureas should be stopped or reduced and insulin doses adjusted, to avoid low blood sugar.[1] The DiRECT diet trial did not include people taking insulin.[2]

Large weight loss can bring type 2 diabetes into remission, with blood sugar below the diabetes line and no medicine needed. This note sets out what diet, surgery and the new drugs achieve, and how long remission lasts.

By attnomSources read on 18 sources5 min read

The size of the problem

WHO estimates that 830 million people had diabetes in 2022, up from 200 million in 1990. More than 95 in every 100 of them have type 2 diabetes, where the body cannot use insulin properly.[3]

What remission means

HbA1c is a blood test that shows average blood sugar over the past two to three months. In 2021 an international expert group agreed to call it remission when HbA1c stays below 6.5 percent for at least three months after all diabetes medicines are stopped. The group chose the word remission, not cure, because the disease can return, and it asked that people in remission keep having regular checks.[4]

Remission through diet

Low-calorie diet replacement programmes

In the DiRECT trial in the UK, 306 adults diagnosed within the last six years took part. For half of them, their GP practice team stopped diabetes and blood pressure medicines and supported them throughout, while they lived on soups and shakes of about 825 to 853 calories a day for three to five months, then slowly returned to normal food. After a year, 46 percent of the diet group were in remission, against 4 percent with usual care. DiRECT counted remission after two months off medicines, not three.[2] Across the trial, remission was reached by 86 percent of those who lost 15 kg or more, and by none of those who gained weight.[2] A trial in Qatar of people aged 18 to 50, diagnosed within three years, found remission in 61 percent after a year, against 12 percent with usual care.[5]

England now offers a 12 month programme of this kind on the NHS, starting with 12 weeks of soups and shakes.[6] Outside a trial, results were lower. Among people who started before 2022 and had the two blood tests needed, 27 percent were in remission after a year. Only 42 percent had both, so the true rate is uncertain.[7]

Remission through surgery

Weight-loss surgery

Weight-loss surgery makes the stomach smaller, and some operations also reroute the gut. In a US trial, five years after surgery 29 percent of gastric bypass patients and 23 percent of sleeve gastrectomy patients had an HbA1c of 6.0 percent or less, against 5 percent on intensive medical care alone. That target allowed medicines, so it is not the same as remission.[8] US guidance says surgery should be considered for suitable people with a body mass index of 30 or more, or 27.5 for Asian American people.[1] Surgery has its own risks: in pooled US trials, anaemia, broken bones and gut problems were more common after surgery.[9]

The new weight-loss drugs

Incretin drugs such as semaglutide and tirzepatide

In people with type 2 diabetes and obesity, tirzepatide cut body weight by 13 to 15 percent over 72 weeks[10] and semaglutide by about 10 percent over 68 weeks.[11] They work while they are taken. In people without diabetes, those who stopped tirzepatide regained much of the lost weight within a year,[12] and those who stopped semaglutide regained about two thirds of it.[13] In a large study in Italy of people starting drugs of this group, three in four on dulaglutide or liraglutide, 5.8 percent reached remission by the strict rule of no diabetes medicine at all, and it lasted about six months on average.[14] One trial gave people diagnosed within five years a 16 week course of an insulin and liraglutide injection, metformin and coaching, then stopped all diabetes medicines. A year later 6 percent were in remission, not clearly more than the 4 percent given usual care.[15] We found no such trial for semaglutide or tirzepatide.

How long remission lasts

In DiRECT, 36 percent of the diet group were in remission at two years.[16] In an extension study that followed people to five years, only 26 percent of those in remission at year two were still in remission.[17] After surgery, a Swedish study that was not a randomised trial found remission in 72 percent at two years and 30 percent at 15 years, against 16 and 7 percent in similar people without surgery. It used a fasting blood sugar test, not HbA1c.[18] In four pooled US trials, remission after surgery was 18 percent at seven years and 13 percent at 12 years, against 6 and 0 percent with medical care.[9]

Even a short remission may help. In the Italian drug study, people whose remission was brief still had fewer new eye, kidney and nerve problems, and people diagnosed more recently were more likely to reach remission.[14] In the Swedish study, people who had surgery had fewer of these problems, and fewer heart attacks and strokes, than similar people who did not.[18] Neither study can prove cause.

What is still unknown

  • What remission means for long-term health. The 2021 expert group said the long-term risks and benefits are not well understood.[4]
  • How many people keep remission in everyday NHS care beyond the first year.[7]
  • Whether the new drugs can lead to lasting remission once they are stopped, or whether they need to be taken for life.[13]
  • Who is best suited to each route. Weight lost is the strongest guide so far,[2] and the expert group lists predicting remission as an unmet need.[4]

This note summarises published research. It is not medical advice. For any question about your own health, or someone in your care, see a doctor.

Sources

Numbered in the order the note first cites them. Each was opened and read on 15 November 2026.

  1. [1]8. Obesity and Weight Management for the Prevention and Treatment of Diabetes: Standards of Care in Diabetes 2026Diabetes Care (American Diabetes Association), 1 January 2026.Read 15 November 2026. Cited 2 times. pmc.ncbi.nlm.nih.gov
  2. [2]Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trialThe Lancet, 10 February 2018.Read 15 November 2026. Cited 4 times. doi.org
  3. [3]Diabetes (fact sheet)World Health Organization, 11 November 2026.Read 15 November 2026. Cited once. www.who.int
  4. [4]Consensus Report: Definition and Interpretation of Remission in Type 2 DiabetesDiabetes Care, October 2021.Read 15 November 2026. Cited 3 times. doi.org
  5. [5]Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trialThe Lancet Diabetes and Endocrinology, June 2020.Read 15 November 2026. Cited once. doi.org
  6. [6]NHS Type 2 Diabetes Path to Remission Programme (page undated; date is when it was read)NHS England, 15 November 2026.Read 15 November 2026. Cited once. www.england.nhs.uk
  7. [7]Early findings from the NHS Type 2 Diabetes Path to Remission Programme: a prospective evaluation of real-world implementationThe Lancet Diabetes and Endocrinology, 5 August 2024.Read 15 November 2026. Cited 2 times. doi.org
  8. [8]Bariatric Surgery versus Intensive Medical Therapy for Diabetes: 5-Year OutcomesNew England Journal of Medicine, 16 February 2017.Read 15 November 2026. Cited once. doi.org
  9. [9]Long-Term Outcomes of Medical Management vs Bariatric Surgery in Type 2 DiabetesJAMA, 27 February 2024.Read 15 November 2026. Cited 2 times. pubmed.ncbi.nlm.nih.gov
  10. [10]Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trialThe Lancet, 26 June 2023.Read 15 November 2026. Cited once. pubmed.ncbi.nlm.nih.gov
  11. [11]Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trialThe Lancet, 2 March 2021.Read 15 November 2026. Cited once. pubmed.ncbi.nlm.nih.gov
  12. [12]Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical TrialJAMA, 2 January 2024.Read 15 November 2026. Cited once. pubmed.ncbi.nlm.nih.gov
  13. [13]Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extensionDiabetes, Obesity and Metabolism, 19 May 2022.Read 15 November 2026. Cited 2 times. pubmed.ncbi.nlm.nih.gov
  14. [14]Type 2 diabetes remission after initiation of GLP-1 receptor agonists: frequency, characteristics, and outcomes using multiple definitions in an observational studyThe Lancet Regional Health, Europe, 15 October 2025.Read 15 November 2026. Cited 2 times. pubmed.ncbi.nlm.nih.gov
  15. [15]Evaluating remission of type 2 diabetes using a metabolic intervention including fixed-ratio insulin degludec and liraglutide: A randomized controlled trialDiabetes, Obesity and Metabolism, 6 September 2024.Read 15 November 2026. Cited once. pubmed.ncbi.nlm.nih.gov
  16. [16]Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trialThe Lancet Diabetes and Endocrinology, 6 March 2019.Read 15 November 2026. Cited once. doi.org
  17. [17]5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension studyThe Lancet Diabetes and Endocrinology, 26 February 2024.Read 15 November 2026. Cited once. doi.org
  18. [18]Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complicationsJAMA, 11 June 2014.Read 15 November 2026. Cited 2 times. pubmed.ncbi.nlm.nih.gov