Can Type 2 Diabetes Be Reversed?

While some people can manage their sugar levels with healthy eating and exercise, around four in five individuals need oral medications, insulin or both to control their blood sugar. Uncontrolled blood sugar levels increase a person’s risk of developing other health problems, such as a heart attack or kidney failure.

With all of the risks, prevention of diabetes is essential. But if someone already has diabetes, can it be reversed? Recent studies suggest that this lifelong condition may indeed go into remission through significant weight loss from lifestyle changes as well as medications and weight-loss procedures.

Here’s what there is to know about diabetes remission.

In this article:

Understanding type 2 diabetes

Diabetes is a lifelong disorder affecting 38.4 million people in the United States. Type 2 diabetes accounts for most (about 90%. percent) of these cases.

Those living with type 2 diabetes have a similar metabolic process to those who don’t, with a few changes. In type 2 diabetes cases, the body breaks down food into glucose (sugar), its primary energy source. The beta cells in the pancreas then secrete insulin, a hormone that helps direct blood sugar into cells to create energy. However, instead of continuing to move into cells, as sugar would in a person who doesn’t live with the condition, sugar builds up in the bloodstream.

This can be dangerous in type 2 diabetes cases, because it can result in blood sugar levels becoming too high. This happens because either the body doesn’t make enough insulin or the body’s cells resist insulin’s effect, ultimately resulting in sugar not being absorbed from the blood.

“When insulin resistance occurs, the body does not respond appropriately to the effects of insulin. This leads to more and more insulin being produced by the pancreas, promoting elevated insulin and high blood sugar levels,” says Jennie Stanford MD, dual board certified in family medicine and obesity medicine.

Can type 2 diabetes go into remission? 

Type 2 diabetes has been viewed by many as a lifelong, possibly progressive condition. However, research now suggests that it is possible for type 2 diabetes to go into remission. Remission, in this case, could mean that a person’s blood sugar level could have the potential to consistently return to a level below the diabetes diagnosis threshold without medication.

Experts hypothesize that a person can achieve and maintain remission on an ongoing basis; however, the state of remission doesn’t mean their diabetes has gone away. “The cellular and metabolic changes in type 2 diabetes are usually persistent even after glucose levels remain in the normal range,” says Dr. Stanford.

There is still no permanent cure for diabetes, which means that recurrence is always a possibility. This makes regular diabetes screening and monitoring essential.

Monitoring can be done at home with blood glucose monitors like the CVS Health Premium True Metrix glucometer and the Freestyle Freedom Lite blood glucose and monitoring system.

If someone has been diagnosed with diabetes, they may have a lifelong risk of high blood sugar due to damaged beta cells of the pancreas and metabolic changes. Factors like illness, and stress and weight gain may lead to elevated blood sugar. These effects vary between individuals, so more research is needed.

Definition of remission

Remission in type 2 diabetes cases occurs when one’s blood sugar level is in a nondiabetic range without taking any blood-sugar-lowering medication. Remission can be diagnosed if a person’s hemoglobin A1C (HbA1C) levels are less than 6.5 percent (below 48 millimoles per mole [mmol/mol]) or if they have a fasting plasma glucose of less than 126 milligrams per deciliter (mg/dL) (or less than 7.0 millimoles per liter [mmol/L]) for at least three months after stopping taking medications.

Lifestyle changes for remission

Losing significant weight and sustaining weight loss is key to achieving remission in many type 2 diabetes cases. Below are different pro-remission lifestyle changes shown to help “reverse” the progression of type 2 diabetes.

Dietary modifications 

The foods someone eats significantly affect blood sugar levels. Being mindful of diet can help control them. Besides lowering sugar levels, dietary modifications can also lead to weight loss, which is a scientifically proven factor in diabetes remission.

Carbohydrates have the biggest impact on blood sugar levels because the sugar in the blood comes from carbohydrates.  Low-carb diets can offer many auxiliary benefits for a remission journey:

• Lower blood sugar levels
• Reduced insulin levels
• Reduced insulin resistance
• Weight-management support

Foods containing carbohydrates are not just a source of energy. They can also provide essential nutrients, including finer, minerals and vitamins, which are vital for various bodily functions. While low-carbohydrate diets can play a role in achieving remission, eliminating carbohydrates entirely may be unhealthy, especially if someone doesn’t replace the necessary nutrients with other food sources.

Instead of focusing solely on reducing the quantity of carbohydrates, it’s crucial to analyze the sources of carbohydrates consumed, emphasizing quality over quantity.  For example, one study found that a whole-food, plant-predominant diet helped some participants with type 2 diabetes achieve remission.

A low-calorie diet (1,200 to 1,500 kilocalories per day) can help promote weight loss and potentially induce diabetes remission. Consuming fewer calories means the body stores less fat, aiding in weight management. Aside from weight loss, other benefits of adopting a low-calorie diet for people with type 2 diabetes include the following:

• Decreased body fat percentage
• Improved blood pressure and triglycerides
• Improved diabetes markers, such as HbA1C levels
• Reduced body mass index (BMI)
• Reduced body circumference

Intermittent fasting, where someone only eats during a specific window within the day, was also noted to be effective in achieving weight loss and inducing remission for at least a year in people with type 2 diabetes. This type of diet also has the potential to reverse insulin resistance and improve blood sugar control overall.

Physical activity

When people exercise, their muscles take up more glucose molecules from the blood as they use them for energy. This effect lowers blood sugar levels and can last up to 48 hours, helping stabilize blood sugar levels when done consistently. Exercise also increases blood flow to a person’s muscles, making it easier for glucose to enter muscle cells.

Physical activity also helps the body use insulin better for up to 24 hours after exercise. This supports the idea that nearly everyone, especially people with type 2 diabetes, should exercise at least 150 minutes a week of moderate activity. Regular exercise also reduces cardiovascular risk and death.

Any type of exercise is good for those living with type 2 diabetes. Some studies have shown that regular aerobic exercise training can improve blood glucose levels in adults with type 2 diabetes and possibly cause a 0.50 to 0.7 percent reduction in HbA1C.

However, a combination of aerobic and resistance exercise training is generally noted to be the most impactful. Some examples of activities include brisk walking, light yard work and casual biking. Speak to a health care provider before starting any significant changes to physical activity.

Weight management

Studies found that type 2 diabetes can result from excessive fat accumulation, which ultimately leads to insulin resistance as well as damage to the insulin-producing cells in the pancreas. Weight loss and ongoing weight management help type 2 diabetes go into remission by reducing fat in the liver and pancreas.

Weight loss doesn’t have to be extreme or fast, either. Studies show that those who lose at least 10 kilograms (about 22 pounds) and sustain it for one to two years are more likely to achieve remission.

Effective weight loss strategies typically involve a combination of diet, exercise and other healthy lifestyle behaviors. Below are a few methods that can help impact sustainable weight loss:

• Aiming for seven to eight hours of sleep. Lack of sleep makes people hungrier and increases cravings for high-calorie foods. Meanwhile, good sleep improves blood sugar levels and insulin sensitivity.
• A low glycemic diet. “A low-glycemic diet has been shown to lead to less insulin release after eating and a slower rise in blood glucose. This helps patients with insulin resistance and type 2 diabetes manage a healthy weight,” explains Dr. Stanford.
• Consuming fewer calories. A low-calorie diet can help reduce carbohydrate intake, decrease fat mass and increase lean body mass, which helps with weight management. However, it’s important to consume the right amount of calories for individual needs. Working with professionals like dietitians can help someone determine their caloric requirements to achieve or maintain their target weight and potentially achieve type 2 diabetes remission.
• Creating a healthy meal plan. A healthy meal plan is not the same for everyone and is based on one’s unique needs. It is best to seek further support from experts like nutritionists for personalized recommendations. However, for many, a healthy meal plan includes fruits, non-starchy vegetables, protein foods and whole grains.
• Staying physically active. Physical activity not only helps to achieve or maintain a healthier weight but also helps reduce the risk of type 2 diabetes complications like high blood pressure and high cholesterol.

Sustaining weight loss and healthy weight management practices are critical for those living with diabetes, because those who regain their weight are more likely to experience a relapse of their condition.

Medical and surgical interventions

If someone needs additional assistance when it comes to weight management, a health care provider might prescribe weight-loss medicines to help them lose weight or weight-loss surgery, in some cases.

“Advances in diabetes medications are ongoing, and they offer hope not only for effective type 2 diabetes treatment but also for valuable risk reduction of type 2 diabetes mellitus complications,” says Dr. Stanford. For instance, some glucose-lowering medications may reduce the risk of stroke and heart disease in patients with type 2 diabetes.

Medications

While general expert consensus states that someone needs to be off diabetes medication for at least three months to be considered in remission, blood-sugar-lowering medications can help kickstart the process by helping keep blood sugar levels within the target range.

Common diabetes medications used for this purpose include the following:

• Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors or “gliptins”): These types of medications increase the production of insulin in the body. The class includes medications like aloliptin, linagliptin, saxagliptin and sitagliptin.
• Metformin: This medication helps to decrease the amount of sugar produced by the liver and also improves insulin sensitivity.
• Sodium-glucose cotransporter 2 inhibitors (SGLT2i or “gliflozins): “These medications cause sugar to be removed from the body through urine. This excess glucose in the urine can increase the risk of genitourinary yeast infections,” explains Dr. Stanford. Examples of common gliflozins include canagliflozin, empagliflozin and ertugliflozin.
• Sulfonylureas: This class of medications stimulates the body’s insulin production to help lower blood sugar.
• Thiazolidinediones (TZDs or glitazones): This class of medication lowers blood glucose by improving the body’s responsiveness to insulin, helping glucose be taken up into cells.

Bariatric surgery

Bariatric surgery is a form of weight-loss surgery that alters the digestive tract’s structure to address diabetes, high cholesterol, obesity and other diseases. The most common types of bariatric surgeries done in the United States include the following:

• Gastric sleeve: This surgery removes a portion of the stomach so a person feels fuller sooner.
• Gastric bypass: A gastric bypass makes the stomach smaller and attaches it to the lower part of the small intestine, bypassing part of the intestines. This change helps the body absorb fewer calories.
• Adjustable gastric band: A gastric band surgery places a small band at the top of the stomach, helping a person feel fuller sooner.

Compared to medications and lifestyle changes, bariatric surgery usually leads to greater, more-sustainable weight loss.

Challenges and considerations

So, can type 2 diabetes go into remission? It depends on a few factors.

Both genetics and lifestyle factors can influence a person’s risk of developing type 2 diabetes. Experts estimate that having a family history of type 2 diabetes makes someone three times more likely to develop type 2 diabetes. This increased risk can also stem from shared poor eating and exercise habits. Other environmental risk factors that can heighten this risk include the following:

• Exposure to toxins
• Lack of access to public health and medical resources
• Illness
• Limited quantity or consumption of healthy, minimally processed food
• Stressful experiences

Reversing diabetes may be possible

While diabetes can’t be cured, people can manage their sugar levels, which can help put them one step closer to achieving remission. Many find that the first step on this journey to remission is weight loss and healthy weight management. This first step can be accomplished in many different ways, with many choosing a combination of a exercise, healthy diet, medications and weight-loss surgery to help them reach and maintain their ideal weight.

A health care provider can help find the best plan for diabetes remission based on specific needs and preferences, taking into account age, lifestyle and other health conditions.

Frequently asked questions

Can type 2 diabetes go away permanently? 

No. There is no cure for diabetes. However, people may be able to manage and control their blood sugar levels to a normal range without the need for medications, possibly reaching a state of diabetic remission. Consult a health care provider to discuss diabetes remission.

What is the fastest way to achieve type 2 diabetes remission?

Many find that reaching and maintaining a healthy weight is the fastest way to get type 2 diabetes to go into remission. Eating a proper diet also plays a crucial role in reversing type 2 diabetes, adds Dr. Stanford. Some health care providers might also recommend medications or procedures (such as bariatric surgery). 

How much weight does someone need to lose for type 2 diabetes remission?

Everyone has unique weight management needs, so the total amount recommended to lose to reach diabetic remission should be identified and monitored by a health care professional. However, studies show that achieving weight loss of 22 pounds or more that is sustained for over 12 to 24 months can lead to diabetes remission.

Is it ever too late to reach type 2 diabetes remission?

Ideally, it’s best to achieve type 2 diabetes remission in the early years after diagnosis, because achieving remission of type 2 diabetes becomes harder the longer someone has diabetes. This difficulty arises because long-term diabetes can lead to poorer pancreatic function. However, it’s never too late to try to achieve type 2 diabetes remission. Even if someone can’t reach remission, lowering blood sugar levels can still greatly benefit them.

Once diabetes goes into remission, is someone still considered diabetic?

Even when someone reaches and maintains normal blood sugar levels, this doesn’t mean the diabetes has “gone away.” They’ll still technically be living with diabetes — it is simply in remission and no longer presenting with the traditional range of symptoms.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.