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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Mechanistic studies from a DiRECT subset consolidated the principle that ectopic fat in the liver and pancreas causes functional injury and β cell failure, which are reversible especially in the early stages.
“was consolidated by mechanistic studies from a DiRECT subset. 7-9”
From 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study (2024) · cites this paper as [9]
The Abstract says that remission is most likely early in type 2 diabetes and can involve partial recovery of insulin secretion. The References list a study linking reduced liver and pancreas fat with β-cell recovery, but the report does not itself say that DiRECT-subset mechanistic studies established that ectopic fat causes functional injury and β-cell failure. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSustained improvements over two years were observed with high (74%) retention, of whom 19% achieved remission by Buse et al. definition and 25% by Riddle et al. 2021 definition.
“Sustained improvements over two years were observed with high (74 %) retention, of whom 19 % achieved remission by the definition of Buse et al. [1] and 25 % according to the Riddle et al. 2021 international consensus definition [2].”
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References 39 · Cited by 464
- 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
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2021-08-30
- Volume
- 44
- Issue
- 10
- Pages
- 2438-2444
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC8929179
- OpenAlex
- W3196921676
- Cited by
- 464
- References
- 39
- Citations by year
- 2026: 92 · 2025: 103 · 2024: 124 · 2023: 72 · 2022: 63 · 2021: 9
- FWCI
- 10.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- McMaster University
- Kowa Company
- Pacira BioSciences
- Cystic Fibrosis Trust (SRC 019)
- Diabetes UK
- Science Foundation Ireland
- Irish Research Council
- Novo Nordisk
- Vetenskapsrådet
- Astellas Pharma
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK020572)
- 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
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