Warm sunrise scene: a content person walks uphill toward the rising sun with symbols for nutrition and movement. Remission means blood sugar can normalise without medication.
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A path that can be worth it – but not a guaranteed cure.
What “remission” actually means
Evidence level: established
Remission means the long-term blood sugar marker HbA1c stays in the non-diabetic range without glucose-lowering medication (usually below 6.5 % or 48 mmol/mol, for at least three months after stopping medication). The key distinction: remission is not a cure. The underlying predisposition remains and values can return – which is why regular check-ups are still needed.
What the DiRECT trial shows – even after five years
Evidence level: established (RCT + extension)
The UK DiRECT trial is the most important study on this. With a structured weight-management programme (first a very low-calorie formula diet, then gradual food reintroduction and support for keeping the weight off), 46 % achieved remission after one year and 36 % after two years.1
Bar chart of remission rates in DiRECT. After 1 year 46 percent, after 2 years 36 percent, after 5 years 13 percent. Of those in remission after 2 years, 26 percent were still in remission after 5 years. Remission is tied to maintaining weight loss. Remission is not a cure.
Remission in the DiRECT trial: over time
Share in remission (intervention, weight-management-based)
0%25%50%
46%
after 1 year
36%
after 2 years
13%
after 5 years
Important: of those in remission at 2 years, 26% were still in remission at 5 years.
Remission hinges on maintaining weight loss – and is not a cure.
The five-year data put this in realistic perspective: after five years, 13 % of participants with available data were still in remission. Of those in remission at year two, around 26 % remained in remission at five years. It was common to regain weight and fall out of remission. Long-term remission is possible, but persists only for a portion of people – closely tied to maintaining weight loss.2
In DiRECT, the active ingredient wasn’t a particular diet but the substantial, maintained weight loss. What matters is the lasting result, and that is hard to maintain in everyday life.
Which paths exist
Besides structured weight programmes with a formula diet, bariatric-metabolic surgery can also lead to remission in pronounced obesity – well studied, but a procedure with its own risks. Which path is suitable depends on the individual situation and belongs in medical hands. In general: the shorter the diabetes has existed and the more weight is sustainably lost, the higher the chance.3
Medication is only reduced or stopped under medical supervision – never on your own. Even in remission, regular check-ups (blood sugar/HbA1c, eyes, kidneys, feet) remain important.
Key takeaways
- Remission = HbA1c in the non-diabetic range without medication – but not a cure.
- DiRECT: 46% (yr 1), 36% (yr 2), 13% (yr 5); ~26% of 2-year remitters stayed to year 5.
- Closely tied to sustained weight loss; relapses are common.
- No single diet leads to remission “reliably” – the maintained result is what counts.
- Bariatric-metabolic surgery is also a path; the choice is individual and medical.
- Check-ups remain necessary even in remission.
Sources
Sources as of: 21 Jul 2026.
- DiRECT: 46% remission after 1 year, 36% after 2 years; formula diet and weight maintenance. Lean et al., Lancet (2018/2019). thelancet.com
- DiRECT 5-year extension: 13% overall remission at year 5; 26% of 2-year remitters still in remission. Lancet (2024). thelancet.com
- Remission definition (HbA1c < 6.5% without medication, ≥ 3 months) and distinction from cure; bariatric-metabolic surgery. Consensus / ADA. diabetesjournals.org