FREE booklet: The GLP-1 Story by Dr. Sayantan Banerjee. Get your copy →

Can Type 2 Diabetes Go Into Remission? What Five Years of Data Show

Yes, for many people. Former NIH scientist Dr. Sayantan Banerjee explains the DiRECT trial, the NHS programme, and what remission rates look like after 1, 2 and 5 years.

TYPE 2 DIABETES REMISSION

Dr. Sayantan Banerjee

10/31/20269 min read

Short answer: yes. A large number of people with type 2 diabetes can bring their blood sugar back into the non-diabetic range and stay off glucose-lowering medicine, some of them for years. The longer answer matters more, because it tells you who has the best chance, how people actually get there, and why some of them slip back.

For a long time, type 2 diabetes was taught as a one-way street. You were diagnosed, you started metformin, and over the years you added more tablets, then perhaps insulin. Many doctors still expect that path. It is true that diabetes tends to progress when nothing changes. But over the past decade, a series of trials in the UK, the US and elsewhere has shown that the path can be changed, sometimes dramatically.

I want to walk through the actual numbers here. You will see bold claims online on both sides. Some people insist diabetes is always progressive. Others promise that a supplement or a 21-day plan will "reverse" it. Neither matches what the trials found.

What remission actually means

In 2021, the American Diabetes Association, the European Association for the Study of Diabetes, the Endocrine Society and Diabetes UK agreed on a shared definition. Remission is an HbA1c below 6.5%, which is 48 mmol/mol, measured at least three months after you have stopped all glucose-lowering medication.

HbA1c, often written as A1C in the US, reflects your average blood glucose over roughly the previous three months. That is why the three-month wait matters. A good result one month after stopping a tablet may still be partly the tablet's effect.

The part people most often miss is the medication rule. An A1C of 6.1% while you take metformin is excellent control. It isn't remission. Remission means your body is managing glucose on its own.

It also isn't a cure. Glucose can rise again, usually if weight comes back. That is why people in remission still need at least a yearly HbA1c check, along with eye, foot and kidney screening.

The trial that changed the conversation

The study that put remission on the map is DiRECT, the Diabetes Remission Clinical Trial. It was run by teams at Glasgow and Newcastle universities and funded by Diabetes UK. Crucially, it took place in 49 ordinary GP practices in Scotland and the north east of England, not in a specialist research unit.

Participants were aged 20 to 65, had been diagnosed within the previous six years, had a BMI between 27 and 45, and were not using insulin. People in the intervention group stopped their diabetes and blood pressure tablets on day one, under medical supervision. They then lived on a nutritionally complete formula diet of about 825 to 853 calories a day for 12 to 20 weeks. After that, food was brought back over two to eight weeks, and they had structured support to keep the weight off.

The results, published in The Lancet in 2017, surprised many specialists. At one year, 46% of the intervention group were in remission, compared with 4% of the control group, who received normal best-practice care. At two years, 36% of the intervention group were still in remission.

What happened after five years

The five-year follow-up was reported in 2024. This is the part that gets less attention, and I think it deserves an honest look.

Across everyone with data at five years, 13% were still in remission. Among people who had been in remission at the end of year two, about 26% remained in remission at year five. So most people did lose remission over time. The main reason was weight regain.

But the story doesn't end there. Over the five years, people in the intervention group spent much more of their time in remission than the control group, about 27% of the time against 4%. And they had about half as many serious illnesses needing a hospital stay: 4.8 versus 10.2 events per 100 patient-years.

In other words, even remission that doesn't last forever seems to bring real benefit. A few years with lower glucose, lower blood pressure and less medication appear to leave people healthier than they would otherwise have been.

Does it work outside a trial?

Trials are run under ideal conditions. The real test is whether ordinary health services can get similar results.

The NHS in England built the DiRECT approach into a national service called the Type 2 Diabetes Path to Remission Programme. The first real-world results were published in The Lancet Diabetes & Endocrinology in 2024. In the early phase, 7,540 people were referred. Among those who completed the programme and had two HbA1c results, 32% were in remission at one year. Among everyone who started before 2022 and had enough data, the figure was 27%.

Average weight loss among completers was about 10 kg, roughly 22 pounds. People who reached remission had lost more, around 16 kg.

So real-world results are lower than in the trial, which is what you would expect when a programme is scaled up to thousands of people. They are still impressive. Roughly one in three people who finished went into remission.

Other routes to remission

Total diet replacement is the best-tested approach, but it isn't the only one.

In the US, the Look AHEAD trial tested an intensive lifestyle programme without formula diets. Remission was less common, about 11.5% in the first year, but still several times more common than with usual care. Its average weight loss was smaller than in DiRECT.

In China, a randomised trial published in 2023 tested an intermittent, calorie-restricted diet in people with type 2 diabetes and relatively low BMIs. After three months of the diet and three months of follow-up, 47% of the intervention group were in remission, compared with about 3% of controls. At 12 months, 44% were still in remission. The average weight loss was about 6 kg. This was a small trial of 72 people, so it needs repeating, but it supports the idea that remission is possible without very large weight loss in some people.

Bariatric surgery produces the highest remission rates of all, particularly gastric bypass. GLP-1 medicines such as semaglutide and tirzepatide also bring many people's HbA1c into the non-diabetic range, although while you are still taking them this counts as good control, not remission.

Who has the best chance?

Three factors come up again and again.

Time since diagnosis. Remission is far more likely in the first few years. Nobody in DiRECT had been diagnosed for more than six years. That doesn't make remission impossible after ten years, but the odds fall over time. The most likely reason is that the insulin-producing beta cells in the pancreas lose more of their function the longer they are under strain.

Amount of weight lost. In DiRECT, remission rose steadily with weight loss. Only 7% of people who lost up to 5 kg reached remission. Among those who lost 15 kg or more, 86% did. I go through these figures in detail in my article on how much weight you need to lose.

Whether you use insulin. People who already need insulin have, on average, less beta-cell reserve. Remission is still possible for some, but less common.

Other factors matter less but still count, including your starting HbA1c, your age, and the number of medicines you take.

Why weight loss works: fat in the wrong places

Professor Roy Taylor at Newcastle, who led DiRECT with Professor Mike Lean in Glasgow, explains remission with what he calls the twin cycle hypothesis.

When we eat more energy than we burn for years, the excess is stored as fat. Up to a point it goes under the skin, where it does relatively little harm. Beyond that point, fat builds up inside the liver and around the pancreas.

Fat in the liver makes the liver resistant to insulin. Normally, insulin tells the liver to stop releasing glucose after a meal. A fatty liver ignores that signal and keeps releasing glucose, which raises fasting blood sugar.

Fat in and around the pancreas seems to impair the beta cells, which make insulin. They respond more slowly and less strongly to rising glucose.

The two problems feed each other, which is why it is called a twin cycle. Higher glucose drives more fat production in the liver, and more liver fat drives higher glucose.

The good news is that the cycle can run backwards. MRI studies from Newcastle showed that when people lose a substantial amount of weight, liver fat falls quickly, within weeks. Fat in the pancreas then falls more slowly, and in many people the beta cells begin to respond normally again.

This also helps explain why some people with a normal BMI get type 2 diabetes. Each of us has a personal fat threshold, beyond which fat spills into the liver and pancreas. That threshold varies from person to person and between ethnic groups. Someone with a BMI of 24 may have crossed their own threshold, and they too can go into remission with a smaller amount of weight loss.

Do you need soups and shakes?

No. Total diet replacement works well because it produces fast, large weight loss with no food decisions. But many people can't face 12 weeks without normal meals, and that is fine.

Lower-carbohydrate diets, Mediterranean-style eating with a calorie deficit, structured intermittent fasting and GLP-1 medicines can all reduce liver fat. What they share is sustained weight loss. The method that works best is usually the one you can still follow a year from now.

Safety first: medicines and low blood sugar

If you take insulin or a sulfonylurea such as gliclazide (common in the UK) or glipizide or glimepiride (common in the US), a sudden drop in calories or carbohydrates can cause low blood sugar, called hypoglycaemia. This can be dangerous, especially if you drive.

If you take an SGLT2 inhibitor such as dapagliflozin or empagliflozin, very low-calorie or very low-carb eating raises the risk of a rare but serious condition called euglycaemic ketoacidosis.

Blood pressure tablets may also need reducing as you lose weight, because blood pressure often falls.

So before you make big changes, talk to your doctor or diabetes nurse. In DiRECT, medicines were stopped on day one, but under close supervision, with regular checks. Never stop or change a prescribed medicine on your own.

A practical plan for the first 90 days

Get your baseline. Write down your current HbA1c in both % and mmol/mol, your weight, your waist measurement, your blood pressure, and every medicine and dose you take.
Book a conversation. Ask your doctor whether remission is a realistic goal for you and which medicines would need adjusting. In England, ask whether you qualify for the NHS Path to Remission programme. In the US, ask whether your health plan covers a medically supervised weight-loss programme or sessions with a registered dietitian.
Pick a method you can live with. Total diet replacement, a structured low-calorie plan, lower-carb eating or intermittent fasting can all work. Choose one and give it at least 12 weeks.
Measure as you go. Weigh yourself once a week, check your waist once a month, and if you have a glucose meter, check fasting glucose a few times a week.
Plan for maintenance before you need it. Decide now what you will eat after the main weight-loss phase, and set a regain limit, for example 2 kg, that triggers a return to stricter eating for a few weeks.
Retest at three months. An HbA1c three months after the start, and three months after stopping any medication, tells you where you stand.

What if you don't reach remission?

Not everyone will, and that isn't failure. In every trial, people who lost weight but didn't reach remission still tended to have lower HbA1c, lower blood pressure, fewer medicines and better quality of life. Each step towards the non-diabetic range lowers your risk of eye, kidney, nerve and heart complications.

The goal is better health. Remission is the best version of that goal, but it isn't the only good result.

How my book can help

I wrote The Type II Diabetes Remission Strategy for exactly this stage. It sets out a 7-step framework and a 16-week programme covering everyday nutrition, strategic intermittent fasting, progressive exercise and daily habits such as sleep and stress control. It includes a Diabetes Remission Diet Plan and a tracker journal for your HbA1c, readings and habits, so you have real data to discuss with your doctor. You can read more on the book page.

Frequently asked questions

Can type 2 diabetes go into remission after 10 years? It can, but it is less common, because beta-cell function tends to decline over time. Lower glucose and fewer medicines are still worth aiming for at any stage. I cover this in a separate article on remission after many years.

Is remission the same as a cure? No. Blood sugar can rise again, particularly with weight regain, so you still need an HbA1c test at least once a year.

How fast can remission happen? In DiRECT, glucose often improved within weeks, as liver fat fell. Remission is confirmed only by an HbA1c at least three months after stopping medication.

Can I go into remission without losing weight? It is unusual. Almost all evidence links remission to weight loss, although the amount needed varies from person to person.

Will I need to stay on a diet forever? You will need to keep most of the weight off. Most people find a sustainable eating pattern, not a strict diet, does that best.

Does remission reduce complications? In DiRECT's five-year follow-up, the intervention group had about half as many serious illnesses needing hospital admission.