People with Type 2 diabetes can achieve remission through diet and lifestyle changes, according to new Kaiser research. Andriy Onufriyenko/Getty Images

People with Type 2 diabetes — especially those with less severe diabetes, and those who are in earlier stages of the disease — can achieve remission through diet and lifestyle changes, according to a new study from the Kaiser Permanente Division of Research.

Diabetes remission is relatively rare, and doctors and researchers have long known that weight loss — particularly through bariatric surgery — is one main way people with diabetes can achieve it. But the new research offers hope that people can also achieve remission through less extreme methods, while noting the challenges of sustaining it.

Previous research has found that about 3% of people with diabetes achieve remission. However, those studies included people who underwent bariatric surgery, while the new Kaiser study excluded people in that category.

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“Our study shows that diabetes remission is possible even outside of bariatric surgery, or outside of tightly controlled clinical trials,” said Luis Rodriguez, a research scientist at Kaiser Permanente Division of Research and the study’s senior author. “This is a hopeful message because we know remission isn’t limited only to intensive interventions.”

The study, published Wednesday in Diabetes Care, included about 560,000 adults with Type 2 diabetes in Hawaii, California, Pennsylvania, Minnesota, Wisconsin and Michigan between 2014 and 2023.

It found that about 16,000 adults, or roughly 3% of the study participants, went into remission after they stopped taking glucose-lowering medications. Most people in the study took Metformin, a common diabetes drug.

Younger people, aged 18 to 29, were more likely to go into remission than adults 75 and older. People who were diagnosed with diabetes more recently — those who had the disease for less than a year, compared to those who had it for four or more years — were also more likely to achieve remission.

The study defined remission as having a hemoglobin A1c of less than 6.5% for at least three months after stopping glucose-lowering medications. A1c is a blood test that measures the average level of blood sugar of the past three months. Anything below 5.7% is considered normal, 5.7% to 6.4% is prediabetic, and 6.5% or higher is diabetic.

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People who started with a lower baseline A1c, 7% or lower, were more likely to go into remission compared to those with a higher baseline A1c, 11% or higher.

The study did not examine exactly how people achieved remission, such as how they changed their diet and exercise habits. But remission is achieved primarily through weight loss, so patients who went into remission mostly did it by losing weight via modifications to diet and lifestyle, Rodriguez said.

Among the participants who achieved remission, 57% lost at least 3% of their body weight.

“The research empowers patients who have Type 2 diabetes because it offers them hope and motivation, especially patients who are in early stages of Type 2 diabetes,” Rodriguez said. “It allows them to know that the earlier they act, the better the chances of achieving remission.”

However, remission was hard to sustain. About 37% of people who initially went into remission had to go back on medication over the subsequent three years, the study found.

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A very small number of people in the study were taking GLP-1 receptor agonists, the class of drugs that includes Ozempic. This is mostly because the study stopped enrolling participants in mid-2020, before these drugs became more accessible and popular. GLP-1 drugs were approved about 20 years ago for Type 2 diabetes, but only in the last few years became more widely used for weight loss.

But the few study participants who were on weight loss drugs were less likely to achieve remission, probably because these medications are often used by patients with more complex or severe cases of diabetes.

More research is needed to determine whether remission should be the goal, and whether it is better than managing diabetes through medication. But preliminary studies and patients’ experiences suggest that remission means lower risk for long-term diabetes complications like heart disease, kidney disease and premature mortality.

“Our study doesn’t suggest that diabetes is easy to reverse, but it does show that with the right support and timely interventions, some patients can achieve remission,” Rodriguez said. “We hope this research can spark more conversations with patients and providers about remission as a goal, not just diabetes management. We also hope it encourages further studies into how to make remission more achievable for more patients.”