Type 2 diabetes can go into remission, and staying there is the hard part

Key takeaways

• In a British trial published in 2018, 46% of people who lived for three to five months on shakes and soups of about 850 calories a day were in diabetes remission a year later, compared with 4% given usual care¹.
• Five years on, 13% of the trial’s dieters who still had data were in remission, and the people who kept more weight off did best².
• The CDC estimates that 40.1 million Americans had diabetes in 2023, including 11.0 million adults who didn’t know it⁶.
• CDC’s diabetes care schedule calls for a yearly dilated eye exam, complete foot exam, kidney tests, cholesterol test, dental exam and hearing check¹².
• A very-low-calorie diet can bring fasting blood sugar to normal within a week, so anyone who takes insulin or a sulfonylurea needs a plan with their clinician before cutting calories or carbs⁴⁵.

Between 2014 and 2017, 306 patients signed up for an unusual test run through 49 family-doctor offices across Scotland and Tyneside, in northeast England¹. All had learned they had type 2 diabetes no more than six years earlier, and none used insulin¹.

At the offices picked for the new approach, patients stopped their diabetes and blood pressure pills at the start, under their doctors’ care. They then lived for three to five months on formula shakes and soups supplying about 825 to 853 calories a day¹. After that came a slow return to ordinary food and ongoing help to keep the weight off¹.

A year later, 46% of that group were in remission, with blood sugar below the diabetes range and no diabetes medicine. At offices giving usual care, 4% were¹. Among everyone who lost at least 15 kilograms, about 33 pounds, 86% were in remission¹.

The trial, called DiRECT, convinced its authors that family doctors could aim for remission, and England’s National Health Service built a program around it¹³.

The five-year follow-up tells the rest of the story². Remission is real, and keeping it takes work. Below, we look at what remission means, how care works in 2026 and the checks that protect you either way.

About 1 in 4 adults with diabetes doesn’t know it

The Centers for Disease Control and Prevention (CDC) estimates that 40.1 million Americans, 12.0% of the population, had diabetes in 2023⁶. Of those, 29.1 million had been diagnosed⁶.

CDC also counts 11.0 million adults with undiagnosed diabetes, 27.6% of adults who have it⁶. That’s a little more than 1 in 4, by our math. About 2.1 million people have diagnosed type 1 diabetes⁶, so most of the others have type 2.

Insulin is the hormone that moves sugar out of the blood and into cells¹³. In type 2 diabetes, the body’s insulin no longer keeps blood sugar in range. One leading explanation comes from Roy Taylor of Newcastle University. In his “twin cycle” idea, first published in 2008, extra fat in the liver spills into the pancreas and switches off the cells that release insulin⁵.

Taylor’s team says each person has a personal fat threshold, so type 2 diabetes isn’t simply a matter of weight⁵. If enough fat comes off within roughly the first six years, the insulin-making cells recover in most people, the team reports⁵.

Diagnosis usually rests on blood tests such as the A1C, which shows your average blood sugar over the past three months⁸. Our article on blood glucose numbers lays out the cutoffs and the conditions that can skew them.

Modern care aims at the heart and kidneys, not only blood sugar

For most people with diabetes, the A1C goal is below 7%, says the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), though goals can differ for people with other health problems⁸. NIDDK builds daily care around the ABCs: A1C, blood pressure, cholesterol and stopping smoking⁸.

The reason is what diabetes does over time. Adults with diabetes are nearly twice as likely as other adults to have heart disease or a stroke, and they tend to get heart disease younger⁹. About 1 in 3 adults with diabetes has kidney disease, usually with no symptoms¹⁰.

The American Diabetes Association (ADA) updates its Standards of Care yearly. The 2026 edition, out December 8, 2025, tightened blood pressure goals for people at high heart or kidney risk and relaxed them for most older adults¹¹. It added guidance on how glucose-lowering medicines can help the heart, kidneys and liver, and it recommended continuous glucose monitors from diagnosis onward for anyone who could benefit¹¹.

The advice moved again in October 2026. The ADA and the European Association for the Study of Diabetes published a joint consensus report, “Management of Type 2 Diabetes, 2026,” in Diabetes Care and Diabetologia⁷. It urges glucose-lowering medicine early in care, with earlier use of two drug families, SGLT2 inhibitors and GLP-1-based therapies, matched to each person’s heart and kidney risk⁷.

The same report widens the checkup to fatty liver disease, heart failure, sleep apnea, anxiety and depression, and gum health⁷. Earlier prescribing also means more sales for drug makers. That doesn’t make the advice wrong, but ask what a medicine would do for someone with your history, and what it would cost.

Remission is real, and for most people it fades

In 2021 an international panel agreed on a definition: an A1C below 6.5% that lasts at least three months with no glucose-lowering medicine⁴. The three-month wait gives the A1C time to settle after medicines stop⁴. DiRECT, which came first, used a slightly shorter two-month window¹.

At two years, 36% of DiRECT’s diet group were in remission². Then 95 of them joined a three-year extension with lighter support².

At five years, 13% of the dieters with data were in remission². Of those in remission at two years, about a quarter (26%) were still there at five². Over the five years, the diet group spent 27% of the time in remission, versus 4% for the usual-care group².

Weight told the story. At five years, people in the extension averaged 6.1 kilograms (about 13 pounds) below their starting weight, versus 4.6 kilograms for the usual-care group². Those still in remission averaged 8.9 kilograms².

The effort paid off even without lasting remission. Across five years, the diet group had less than half the rate of serious medical events, such as hospital stays, of the usual-care group: 4.8 versus 10.2 per 100 person-years².

Who is most likely to get there? Remission usually takes losing 10% to 15% of body weight, ideally soon after diagnosis, the DiRECT team wrote in 2022⁴. Starting traits mattered much less⁴. In DIADEM-I, a similar trial in the Middle East and North Africa whose volunteers had had diabetes for a shorter time, 61% were in remission at a year, versus 12% of controls⁴.

Weight isn’t the whole story. Newcastle’s team reports that in its ReTUNE study of people with a body mass index of 21 to 27, 70% reached remission after losing an average of 6.5% of their weight⁵. The team’s page doesn’t give the study’s size, so treat that as early evidence.

The real-world test. England’s National Health Service turned the approach into the Type 2 Diabetes Path to Remission program, starting in September 2020³. To qualify, you must be 18 to 65 and within six years of diagnosis. The BMI floor is 27 for white adults and 25 for people from ethnic minority groups³. Meal replacements last up to 12 weeks, and support continues for the rest of the year³.

The first published results tracked 1,740 people who began before January 2022³. Only 945 completed the full year. Among them, about 1 in 3 (32%) reached remission, with an average loss of 16 kilograms, about 35 pounds³. By our math, about 46% of starters didn’t complete the year, so the share among everyone who began was lower.

Diabetes UK, the charity that paid for DiRECT, stresses that missing remission, or slipping out of it, is no personal failure¹³. Our low-carb article covers another route.

Your yearly diabetes care checklist

This checklist is our own, built from CDC and NIDDK guidance. If your diabetes goes into remission, ask which checks should continue.

Check	How often	Who says so	Why it matters
A1C blood test	Every 6 months if you’re meeting goals; every 3 months if not, or if treatment changed	CDC12	Shows average blood sugar over about 3 months8
Blood pressure, weight and medicine review	At each visit, every 3 to 6 months	CDC12	Heart disease and stroke risk is nearly double9
Foot check	You: every day. Clinician: complete exam yearly, more often after foot problems	CDC12	Report cuts, sores, blisters, redness or swelling right away12
Dilated eye exam	Yearly, more often if you have eye problems	CDC12	Keeping your ABCs on target may lower the risk of blindness8
Kidney tests: urine albumin and a blood filtration test	Yearly	CDC, NIDDK1012	Kidney disease affects about 1 in 3 and is usually silent10
Cholesterol test	Yearly	CDC12	Some people need a statin to protect the heart8
Dental exam	Yearly; tell your dentist you have diabetes	CDC12	Gum disease and blood sugar affect each other; see our dental article
Hearing check	Yearly	CDC12	Part of CDC’s yearly list
Vaccines	Flu shot yearly; pneumonia and hepatitis B depending on age	CDC12	See our article on vaccine schedules
Mood check	Whenever you feel sad or hopeless	CDC12	Tell your clinician right away

On a lab report, the urine test often appears as uACR (urine albumin-to-creatinine ratio) and the blood test as eGFR (estimated glomerular filtration rate).

Know the emergency signs before you need them

Diabetic ketoacidosis (DKA). DKA is most common in type 1, but people with type 2 can develop it too, CDC says¹³. When the body lacks insulin, it burns fat for fuel, and acids called ketones build up¹³.

Early signs are heavy thirst and urinating much more than usual. Later signs include fast, deep breathing, fruity-smelling breath, a flushed face, nausea or vomiting, stomach pain and deep tiredness¹³. CDC says to call 911 or go to the emergency room right away if¹³:

• your blood sugar remains 300 mg/dL or higher
• your breath smells fruity
• you’re vomiting and can’t keep food or liquids down
• you have trouble breathing
• you have several DKA signs at once

Low blood sugar. For most people with diabetes, below 70 mg/dL is too low; shakiness, headache and a cold sweat are common signs⁸. Very low blood sugar can cause confusion or fainting, a serious emergency that needs treatment right away⁸. Glucagon, a hormone that raises blood sugar, is the best treatment for a severe low, so if you have a prescription, show family and coworkers how and when to use it⁸.

Very high blood sugar. Above 180 mg/dL is high for most people. Thirst, tiredness and blurry vision are signs, and very high levels can cause confusion or fainting that needs treatment right away, NIDDK says⁸.

Heart attack or stroke. Diabetes-related nerve damage can hide chest pain, NIDDK warns, so know the other signs too⁹. Call 911 right away for chest pain or pressure that lasts more than a few minutes or keeps coming back; discomfort in the arms, shoulders, back, neck or jaw; shortness of breath; sweating or lightheadedness; nausea; or unusual tiredness⁹. For a stroke, call 911 if one side of the face or body suddenly goes weak or numb, or for sudden confusion, trouble speaking or seeing, loss of balance, or a sudden severe headache⁹.

Food is the engine of remission, but pills sold as cures are not

DiRECT is, at heart, a food-and-weight trial, and a diabetes charity paid for it, not a drug company¹. If you believe food can be medicine, this is your evidence.

The diet industry deserves the same scrutiny as drug makers. In the DiRECT team’s 2022 review, one author reported research support from Cambridge Weight Plan, a formula-diet company, for other work⁴. Another, M.E.J. Lean, who led the trial report, reported unpaid medical advice to Counterweight, a weight-management firm¹⁴.

The ADA’s 2026 Standards name Mediterranean-style and low-carbohydrate eating as patterns with evidence for preventing type 2 diabetes¹¹. Our articles on healthy eating patterns and low-carb diets cover those trials.

Movement matters too. NIDDK advises at least 150 minutes a week of moderate activity, such as brisk walking, plus muscle-strengthening on two days⁸. Later articles cover activity, sleep and supplements sold for blood sugar.

Be wary of products sold as diabetes treatments. FDA’s health-fraud page lists warning letters to 15 U.S. and foreign companies that sold such products online and in stores, including dietary supplements and ayurvedic remedies¹⁴. The agency says it hasn’t evaluated or approved them as safe or effective for diabetes, and it advises checking with a health professional before you buy¹⁴.

Some herbal pills even hide prescription drugs, as our article on supplement adulteration explains. Bring the same skepticism to every seller, whether the label says “pharmaceutical” or “natural.”

A diet change can drop your blood sugar within days

In Newcastle’s 2011 Counterpoint study, fasting blood sugar returned to normal within seven days of starting a very-low-calorie diet⁵. That speed is good news, and a hazard if you take medicine that lowers blood sugar.

DiRECT’s doctors stopped glucose-lowering pills on day one. The team explains why: it was a safety step to head off low blood sugar as weight came off⁴. They stopped blood pressure pills too, to avoid dizziness from pressure that drops too far when you stand¹⁴.

So if you take insulin, a sulfonylurea or any other glucose-lowering medicine, make a plan with your clinician before you cut calories or carbs. If lows become frequent, NIDDK says, your meal plan, activity or medicines may need to change⁸. If you take blood pressure pills, ask how to track your readings as your weight comes down.

Never ration or skip medicine to save money, NIDDK warns⁸. Tell your care team about cost problems instead.

Very-low-calorie diets aren’t right for everyone. If restriction or weight loss has been a struggle for you, talk with your clinician first. The National Alliance for Eating Disorders helpline is 1-866-662-1235, and in a crisis you can call or text 988.

How strong is the evidence?

Claim	Evidence level	What the research shows
Major early weight loss can put type 2 diabetes into remission	Strong evidence	DiRECT: 46% vs. 4% at one year; DIADEM-I: 61% vs. 12%14
One round of dieting keeps diabetes away for good	Evidence says no, or unsafe	13% of DiRECT dieters with five-year data were in remission2
A national program can match trial results	Promising but early	32% of NHS completers; no comparison group3
People who aren’t heavy can reach remission with modest weight loss	Promising but early	A Newcastle study reports 70% at BMI 21 to 275
SGLT2 inhibitors and GLP-1 drugs protect the heart and kidneys in people at risk	Strong evidence	Built into the ADA’s 2026 Standards and the 2026 ADA/EASD consensus711
Products sold online as diabetes cures work	Not enough evidence	Not evaluated or approved by FDA, which has warned sellers14

Questions readers ask

The bottom line

Type 2 diabetes is no longer a one-way street. Large, early weight loss, often from a closely supervised low-calorie program, can bring blood sugar back below the diabetes range without medicine. For most people, though, remission fades unless the weight stays off, so treat it as a phase to protect, not a finish line.

Whatever your path, the yearly checks for eyes, feet, kidneys, heart and teeth still matter. Food and movement are powerful tools, and modern medicines can help guard the heart and kidneys. If you take insulin, a sulfonylurea or blood pressure pills, make any diet change part of a plan with your clinician.

Related reading

• Metabolic syndrome is just five numbers that together still predict trouble
• Low-carb can mean 20 grams or 200, and what replaces the carbs matters most
• Eight healthy eating patterns faced a 30-year test and mostly agreed
• Some healthy habits clash with your medicines, so check these goals first
• Some herbal pills hide prescription drugs, and others swap out the herb

Sources

1. 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.” Lancet, 2018;391:541–551 (University of Glasgow record). eprints.gla.ac.uk
2. Newcastle University. “Diet links to longer remissions of type 2 diabetes and improved health” (on the DiRECT five-year extension, Lancet Diabetes & Endocrinology, 2024). Press release, February 2024. ncl.ac.uk
3. Diabetes UK. “NHS ‘soups and shakes’ diet study shows one third of people with type 2 diabetes enter remission.” August 6, 2024. diabetes.org.uk
4. Noronha JC, Thom G, Lean MEJ. “Total Diet Replacement Within an Integrated Intensive Lifestyle Intervention for Remission of Type 2 Diabetes: Lessons From DiRECT.” Frontiers in Endocrinology, 2022;13:888557 (University of Glasgow PDF). eprints.gla.ac.uk
5. Newcastle University Magnetic Resonance Centre. “Reversing Type 2 Diabetes.” Accessed October 2026. ncl.ac.uk
6. Centers for Disease Control and Prevention. “National Diabetes Statistics Report: At a Glance.” Updated September 16, 2026. cdc.gov
7. American Diabetes Association. “Leading Diabetes Organizations Publish Joint Consensus Report on Management of Type 2 Diabetes” (on “Management of Type 2 Diabetes, 2026: A Consensus Report by the American Diabetes Association and the European Association for the Study of Diabetes,” Diabetes Care and Diabetologia). Press release, October 2, 2026. diabetes.org
8. National Institute of Diabetes and Digestive and Kidney Diseases. “Managing Diabetes.” NIH, reviewed October 2023. niddk.nih.gov
9. National Institute of Diabetes and Digestive and Kidney Diseases. “Diabetes, Heart Disease, & Stroke.” NIH, reviewed April 2021. niddk.nih.gov
10. National Institute of Diabetes and Digestive and Kidney Diseases. “Diabetic Kidney Disease.” NIH, reviewed February 2017. niddk.nih.gov
11. American Diabetes Association. “The American Diabetes Association Releases ‘Standards of Care in Diabetes—2026’.” Press release, December 8, 2025. diabetes.org
12. Centers for Disease Control and Prevention. “Your Diabetes Care Schedule.” Updated 2023, republished 2024. cdc.gov
13. Centers for Disease Control and Prevention. “Diabetic Ketoacidosis.” May 15, 2024. cdc.gov
14. U.S. Food and Drug Administration. “Illegally Sold Diabetes Treatments.” Health Fraud Scams, content current as of September 30, 2020. fda.gov