Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes
Open accessAbstract
Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks versus benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed “remission” as the most appropriate descriptive term, and HbA1c < 6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.
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LCD increases the likelihood of T2D reversal, defined as return of blood glucose levels to below the threshold diagnostic of diabetes whilst on metformin.
“In addition, there is evidence indicating that LCD increases the likelihood of “T2D remission”, which is defined as maintaining “HbA1c < 6.5% measured at least 3 months after cessation of glucose-lowering pharmacotherapy,” and of “T2D reversal”, a term used to describe the return of blood glucose levels to below the threshold diagnostic of diabetes, whilst on metformin11,12.”
From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [11]
The passage on terminology (indexed as Abstract; page unavailable) defines reversal as returning to glucose levels below those diagnostic of diabetes. It does not make continued metformin use part of that definition. The paper discusses nutritional changes generally, but does not say that LCD increases the likelihood of reversal. (LLM, conf=0.88)
Experimental — accuracy not yet measuredLCD increases the likelihood of T2D remission, defined as maintaining HbA1c <6.5% measured at least 3 months after cessation of glucose-lowering pharmacotherapy.
“In addition, there is evidence indicating that LCD increases the likelihood of “T2D remission”, which is defined as maintaining “HbA1c < 6.5% measured at least 3 months after cessation of glucose-lowering pharmacotherapy,” and of “T2D reversal”, a term used to describe the return of blood glucose levels to below the threshold diagnostic of diabetes, whilst on metformin11,12.”
From mHealth low carbohydrate dietary intervention ameliorates glycaemic profile, blood pressure and weight status in people with type 2 diabetes (2025) · cites this paper as [11]
The Conclusions define T2D remission as HbA1c <6.5% persisting for at least three months without usual glucose-lowering pharmacotherapy. The paper discusses remission after lifestyle changes, but the passages do not establish that LCD specifically increases its likelihood. (LLM, conf=0.88)
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References 40 · Cited by 92
Research works printed but not linked: 1
- [29]29. Hundal RS, Inzucchi SE. Metformin: new understandings, new uses. Drugs. 2003;63(18):1879-1894. [DOI] [PubMed] [Google Scholar]
- Authors
- Riddle, M. C., Cefalu, W. T., Evans, P. H., Gerstein, H. C., Nauck, M. A., Oh, W. K., Rothberg, A. E., le Roux, C. W., Rubino, F., Schauer, P., Taylor, R., & Twenefour, D.
- Affiliations
- Oregon Health & Science University (US)
- National Institutes of Health (US)
- University of Exeter (GB)
- Population Health Research Institute (CA)
- St. Josef-Hospital (DE)
- Tisch Cancer Institute (US)
- University of Michigan (US)
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
- King's College London (GB)
- Pennington Biomedical Research Center (US)
- Newcastle University (GB)
- Diabetes UK (GB)
- Corresponding author
- Riddle, Matthew C
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2021-08-30
- Volume
- 107
- Issue
- 1
- Pages
- 1-9
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC8825709
- OpenAlex
- W3197695207
- Cited by
- 92
- References
- 40
- Citations by year
- 2026: 15 · 2025: 23 · 2024: 17 · 2023: 18 · 2022: 15 · 2021: 4
- FWCI
- 10.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 2 diabetes, diabetes remission, HbA1c, remission definition, nomenclature, remission monitoring, predictors of remission, risk-benefit assessment
- MeSH terms
- Healthy Lifestyle, Blood Glucose, Diabetes Mellitus, Type 2, Endocrinology, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Treatment Outcome, Practice Guidelines as Topic, Consensus, Bariatric Surgery
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