Type 2 DiabetesHow to Manage Type 2 Diabetes

How to Stay in Diabetes Remission

How to Stay in Diabetes Remission
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Updated on March 21, 2025
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Reaching type 2 diabetes remission is a major milestone. Remission means maintaining a hemoglobin A1C status of below 6.5 percent for at least three months without taking any glucose-lowering medications.

 It can come with many benefits for people living with type 2 diabetes; blood sugar levels stay in a healthy range, and the risk of diabetes-related complications decreases.

 But remission isn’t a cure; people in diabetes remission need to maintain the healthy habits that got them there, because blood sugar levels can rise again if these habits slip.

Staying in remission takes effort, but it’s doable.

 Here’s what you need to know about maintaining your success for the long term.

How Often Do People With Diabetes Achieve Remission?

Weight loss is the most important factor in achieving remission.

 Obesity causes adipose tissue to become dysfunctional, promoting a pro-inflammatory, hyperlipidemic, and insulin-resistant environment that contributes to type 2 diabetes;

 weight loss is able to reverse this. In a study of nearly 300 people with type 2 diabetes, about half went into remission after one year of following a strict diet plan and losing weight. By the second year, however, some people regained weight, and overall, only about 1 in 3 people maintained remission.

Evidence suggests remission is more likely the more weight patients lose. For example, in a two-year study, nearly two-thirds of participants who lost at least 22 pounds (10 kilograms) achieved remission, and about 1 in 3 stayed in remission for at least two years through diet changes and weight loss.

 Starting early may also make a difference; another study found that people who worked on achieving remission within their first year of diagnosis were almost three times more likely to succeed than those who waited three to five years.

 Those who undergo weight loss surgery are generally more successful at achieving and maintaining remission.

Remission is rare without treatment. Looking at nearly 2.3 million people with type 2 diabetes in England, researchers found that about 10 out of 1,000 people achieved remission each year without intervention.

Reducing body fat, especially around the liver and pancreas (the so-called visceral fat, which is more dangerous than subcutaneous fat), can help restore your body’s ability to control blood sugar.

 But losing weight and keeping it off isn’t always easy. It often requires long-term changes to eating habits and increased physically activity.

Talk with your healthcare provider if you’re thinking about working toward type 2 diabetes remission. They can help you understand what steps to take and what remission might look like for you.

Lifestyle Tips for Staying in Diabetes Remission

Staying in remission often means making lasting lifestyle changes that support healthy blood sugar levels in addition to medical treatment.

 The following tips can help you maintain your progress.

Manage Your Weight

Achieving and maintaining remission depends largely on weight management, says Priyanka Majety, MD, an assistant professor of endocrinology, diabetes, and metabolism at Virginia Commonwealth University in Richmond. “The largest and strongest evidence comes from the DiRECT trial, which showed that lifestyle interventions, including weight management, have promoted the achievement and maintenance of diabetes remission,” she adds.

The study had three key phases: an initial period of rapid weight loss with a very low-calorie diet (about 825 calories per day for up to 20 weeks), gradual reintroduction of whole foods, and long-term weight maintenance phase.

 Dr. Majety explains that a major takeaway from the trial was the importance of monitoring to help study participants get back on track if they gained weight.
Finding a weight management approach you can stick with is important. Extreme or overly restrictive diets might work short-term but can be difficult to maintain and sometimes lead to unhealthy eating patterns.

 The definition of obesity also is changing given long-standing concerns about body mass index.

 Talk with your healthcare provider or dietitian about creating a sustainable plan that fits your lifestyle and preferences.

Follow a Healthy Diet

Research hasn’t found one specific diet that works best for staying in remission, Majety says. The eating plan that works best is one you can maintain over time, she adds.

When we regularly eat more calories than we need, extra carbohydrates turn into fat, which builds up in the liver and eventually affects the pancreas (the organ that makes insulin). This process, known as the twin cycle, affects how well your body produces and uses insulin. Weight loss through healthy eating can reverse this cycle by reducing fat in both the liver and pancreas and improving insulin sensitivity.

Very low calorie diets (between 400 and 500 calories a day) have the highest success rates for achieving remission, but they require medical supervision

 and aren’t meant to be followed for more than 12 weeks.

 The Mediterranean diet, which includes plenty of vegetables, whole grains, fruits, lean meats, nuts, and olive oil,

 has also helped people achieve remission, says Majety. It may not work as quickly as very low calorie diets, but it can be easier to stick with as you work to stay in remission, she adds.

Plant-based diets also help many people achieve and maintain diabetes remission.

 This might include a vegan diet, which excludes all animal products, or a vegetarian diet that includes some dairy and eggs. These approaches can help you keep your calories in check while providing the nutrition you need.

Your doctor and dietitian can help you find the right eating plan to stay in type 2 diabetes remission. Consider these tips when planning your meals.

  • Choose foods that digest slowly, such as whole-grain bread and pasta, brown rice, or sweet potatoes.
  • Pick protein-rich food, such as fish, skinless chicken, beans, lentils, or eggs.
  • Include healthy fats like olive oil, avocados, nuts, or seeds.
  • Fill half your plate with nonstarchy vegetables.
  • Drink water instead of sugary beverages.
  • Keep portions moderate, even with healthy food.

Exercise

Regular exercise can not only help with weight management, but it can also improve how the body uses insulin.

 This means the pancreas doesn’t have to work as hard to control blood sugar.
“The more you move, the longer you stay in remission,” Majety says. Exercise helps to activate receptors called GLUT-4 in our muscles that help remove glucose from the blood, she explains.

 This process helps keep blood sugar levels stable, which can support long-term remission.
Majety recommends two types of exercise for staying in remission.

Resistance Training (Two to Three Times per Week)

Aerobic Exercise (at Least 150 Minutes per Week)

Good-quality sleep is also important for staying in remission. Poor sleep can disrupt the hormones that control hunger (ghrelin and leptin) and increase insulin resistance, Majety says, making it harder to maintain a healthy weight. Try to maintain a regular sleep schedule, and aim for seven to eight hours of sleep each night.

When to See a Doctor During Diabetes Remission

Regular medical checkups remain important after you achieve remission, says Chhaya Makhija, MD, a board-certified endocrinologist at Unified Endocrine and Diabetes Care in California. “Initially, we may check A1C levels every 3 to 4 months. If levels stay stable, we can extend this to every 6 to 12 months,” she explains.

Dr. Makhija encourages many of her patients who achieve diabetes remission to use continuous glucose monitoring (CGM) devices, which track blood sugar in real time. This can help catch changes caused by other factors that could affect blood sugar levels, such as stress and illness, even if you’re following a healthy diet and getting regular exercise, she says.

During your follow-ups, your healthcare provider may also check for any diabetes-related complications affecting your eyes, nerves, kidneys, or heart. Makhija explains that sometimes rapid improvements in blood sugar control can temporarily worsen existing complications, which is why ongoing medical supervision is important.

Long-Term Health Effects of Diabetes Remission

Evidence so far suggests that achieving remission can reduce long-term diabetes complications, but more research is needed.

 High blood sugar can damage various parts of your body, including your eyes, nerves, limbs, and kidneys.
In one large study that followed participants for 18 years, those who stayed in remission after weight loss surgery had fewer health problems. They had reduced rates of complications affecting both the small blood vessels (in the eyes and kidneys) and large blood vessels (like those supplying the heart). People who lost more than 10 percent of their body weight had a 21 percent lower risk of heart problems.

A study that followed people for 12 years found that achieving remission through lifestyle changes lowered the risk of kidney disease by 33 percent and heart problems, such as heart attacks and stroke, by 40 percent.

 These benefits increase the longer someone stays in remission. This reinforces the importance of staying in diabetes remission as long as possible, but we need more research to understand both the short- and long-term effects of remission, explains Makhija.

Can Diabetes Come Back After Remission?

Diabetes can become active again if certain factors change.

“If blood sugar levels rise above certain thresholds due to lifestyle changes or other triggers, a person would no longer be considered in remission,” explains Makhija. A1C must increase to above 6.5 percent, or other diabetes tests must show blood sugar has returned to diabetic levels, she adds.

Blood sugar typically moves through different stages.

  • Normal A1C below 5.7 percent, fasting blood sugar below 100 milligrams per deciliter (mg/dL).
  • Prediabetes A1C between 5.7 percent and 6.4 percent, fasting blood sugar 100–125 mg/dL.
  • Diabetes A1C at or above 6.5 percent, fasting blood sugar at or above 126 mg/dL
You might not notice any symptoms when blood sugar first starts to rise.

 Makhija notes that symptoms like increased thirst, frequent urination, fatigue, or blurred vision usually don’t appear until blood sugar levels reach between 180 and 300 mg/dL or higher.

 Regular monitoring during remission can help catch any changes early. Contact your healthcare provider right away if you notice these symptoms.

Know that it’s possible to work toward remission again if diabetes does return. Your healthcare provider can help you adjust your management plan and support you getting back on track.

The Takeaway

  • Type 2 diabetes remission means maintaining an A1C below 6.5 percent for at least three months without glucose-lowering medication.
  • Losing weight and keeping it off, healthy eating, and regular exercise can improve insulin function and help you stay in remission.
  • Maintaining remission is a long-term commitment that includes regular healthcare visits, because diabetes can return even after successful remission.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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Anna L. Goldman, MD

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Anna L. Goldman, MD, is a board-certified endocrinologist. She teaches first year medical students at Harvard Medical School and practices general endocrinology in Boston.

Dr. Goldman attended college at Wesleyan University and then completed her residency at Icahn School of Medicine at Mount Sinai Hospital in New York City, where she was also a chief resident. She moved to Boston to do her fellowship in endocrinology at Brigham and Women's Hospital. She joined the faculty after graduation and served as the associate program director for the fellowship program for a number of years.

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