Type 2 diabetes remission: what the research shows

By Dan Remon · Evidence checked October 2026

A type 2 diabetes diagnosis usually comes with a prescription and one line about diet and exercise. The research says that line deserves more of your attention.

In the best-known trial, close to half the people on an intensive weight-loss program run through UK general practices had blood sugar below the diabetes range a year later, without diabetes medication. Researchers call that remission. It doesn’t happen for everyone, it depends heavily on how much weight comes off, and it can return if the weight does.

This is what the trials found, and 5 steps to take with your doctor. I’m a coach. Your doctor manages the diabetes and the medication, and my part is the habits that keep the plan running.

Can type 2 diabetes be reversed?

The term the research uses is remission: an HbA1c below 6.5% (48 mmol/mol), measured at least 3 months after stopping all glucose-lowering medication.¹ In the DiRECT trial, 46% of people on an intensive weight-management program were in remission at 12 months, against 4% on usual care. The more weight people lost, the more likely remission was.² An international expert group chose the word remission because the improvement may not be permanent and needs ongoing monitoring.¹ It’s most likely early after diagnosis and with substantial weight loss. Any attempt belongs with your doctor, especially if you take medication.

What the DiRECT trial found

DiRECT ran in 49 general practices in Scotland and Tyneside in England. Its 306 adults, aged 20 to 65, had been diagnosed within the previous 6 years, had a BMI of 27 to 45 and weren’t using insulin.²

The program had 4 parts: diabetes and blood pressure medication stopped, a formula diet of 825 to 853 kcal a day for 3 to 5 months, food reintroduced in steps over 2 to 8 weeks, then structured support to keep the weight off. Practices were randomised to run it or to give best-practice usual care.

At 12 months, the program group had lost 10.0 kg on average, against 1.0 kg in the control group. 46% were in remission, against 4%. Across everyone in the trial, remission tracked weight loss closely:

• Gained weight: none of 76 people in remission.
• Lost 0 to 5 kg: 7%.
• Lost 5 to 10 kg: 34%.
• Lost 10 to 15 kg: 57%.
• Lost 15 kg or more: 86%.

The follow-up matters as much as the headline. At 2 years, 36% of the program group were in remission. Of those in remission at 2 years, 26% were still in remission at 5 years. Among people who stayed on low-intensity support through year 5, 13% were in remission at the end.³

What I take from DiRECT: weight loss drove remission, and keeping the weight off was the hard part. That second part is a habits problem, which is where coaching earns its place.

Does it work without a formula diet?

A program without a formula diet produced smaller numbers. Look AHEAD, a US trial of 4,503 adults with type 2 diabetes and overweight, compared an intensive lifestyle program of diet, activity and regular counselling with diabetes support and education. The lifestyle group lost 7.9% more weight in the first year. In an observational analysis of the first 4 years, 11.5% of the lifestyle group were in partial or complete remission during the first year and 7.3% at year 4, against 2.0% in the education group. The authors described the absolute remission rates as modest.⁴

DiRECT aimed for larger weight loss with a formula diet and recruited people within 6 years of diagnosis. Timing matters: the consensus report notes that a return to near-normal blood sugar is most likely early in the course of type 2 diabetes.¹

What remission means

Remission means your blood sugar sits below the diabetes range without medication. The definition comes from a 2021 consensus report by an expert group convened by the American Diabetes Association, with Diabetes UK among the organisations represented.¹ 3 points from that report are worth knowing before you start:

• It can come back. Weight gain, other illness and a continuing decline in the body’s ability to make insulin can all bring type 2 diabetes back. HbA1c gets tested at least once a year.
• Check-ups continue. Complications can still develop after remission, so eye screening, kidney tests, foot checks, blood pressure and weight stay on the schedule.
• Lifestyle changes take time to show. The group advises at least 6 months after starting a lifestyle change before HbA1c can reliably show the response.

5 steps to take with your doctor

1. Start with your doctor and your medication

This comes first because changing how you eat can make some medication unsafe. Diabetes UK advises speaking to your diabetes healthcare team before you change your diet or activity. If you take insulin or a sulphonylurea, eating fewer carbohydrates or losing weight without adjusting the dose can push your blood sugar too low, which is called a hypo. If you take an SGLT2 inhibitor, cutting carbohydrates without adjusting it can lead to ketoacidosis, a very serious condition. Blood pressure medication may need changing as weight comes off.⁵

Ask for a baseline HbA1c, blood pressure and weight, and agree how often you’ll recheck them. If you have diabetic eye disease, raise it before you start. The consensus report advises avoiding a rapid fall in blood sugar in that situation, and repeating eye screening if it drops quickly.¹

2. Make weight loss the main target

In DiRECT, remission rose with every band of weight lost, and the 5-year report describes sustained weight loss as the dominant driver of remission.^2,3 Ask your doctor whether a structured program, including a supervised low-calorie formula diet, suits you. For the habits that make weight loss hold on a busy schedule, start with weight loss for busy executives. If the scale stalls partway, why the scale stalls explains what’s happening.

3. Cut sugary drinks and refined carbohydrates

Lower-carbohydrate eating has trial evidence behind it, with limits. A 2021 meta-analysis of 23 randomised trials with 1,357 people with type 2 diabetes looked at diets under 130 g of carbohydrate a day. In the 8 trials that reported it, 57% of people on the lower-carbohydrate diets had an HbA1c below 6.5% at 6 months, against 31% on control diets. That definition allowed people to stay on diabetes medication. When remission meant being off medication, the effect was smaller and not statistically significant. By 12 months, remission data were sparse and the gains in weight and blood fats had shrunk.⁶

What I start with: water, tea and coffee as your drinks, added sugar and refined carbohydrates such as white bread, pastries and biscuits cut right back, and protein and vegetables first on the plate. If you snack, choose nuts, olives or hummus over biscuits, or skip the snack. Fats from whole foods such as avocado, olives and almonds have a place too. On insulin, a sulphonylurea or an SGLT2 inhibitor, cut carbohydrates only with your doctor’s input. If sugar is the hard part, read how to stop sugar cravings and what added sugar does to you.

4. Consider an eating window

Time-restricted eating means eating within a set window each day. In a 6-month randomised trial of 75 adults with obesity and type 2 diabetes, eating only between 12pm and 8pm, without counting calories, led to the loss of 3.56% more body weight than in the control group. HbA1c fell by 0.91 percentage points with the eating window and by 0.94 with daily calorie counting, compared with control, and the 2 approaches didn’t differ. No serious adverse events were reported.⁷

It’s one way to eat less without tracking every meal, and some people find it easier to keep. It was a small trial, and fasting while on insulin or a sulphonylurea needs your doctor’s input first.

5. Train, and include strength

A 2011 meta-analysis of 47 randomised trials with 8,538 people with type 2 diabetes found structured exercise training was associated with a 0.67 percentage point fall in HbA1c. Aerobic training, strength training and both combined were each associated with lower HbA1c. More than 150 minutes a week was linked to a larger fall (0.89 points) than 150 minutes or less (0.36). Advice to be more active was only linked to lower HbA1c when it came with dietary advice.⁸

Advice alone isn’t enough, so I make training a scheduled part of the week: 2 to 3 strength sessions plus walking, built up gradually and cleared with your doctor first.

Keeping it: where coaching fits

The trials share a pattern. Results were strongest while people kept the changes going, and they faded as weight came back. In the DiRECT extension, people who kept receiving low-intensity support had a larger share of their yearly measurements in remission than those whose support stopped (34% against 12%).³ The groups weren’t randomised, so it’s an association, but it points the same way as the rest of the trial.

That’s the part I coach. Your doctor tracks HbA1c, blood pressure and medication. I track the daily inputs that move them.

The tool is the Stealth Tracker, a 60-second daily check-in on your phone and part of the Stealth OS. For this work, it records the inputs you’ve agreed with your doctor: whether you trained, how you ate against the plan, how you slept, and what got in the way on the days it slipped. HbA1c moves over months. The Tracker shows the daily pattern behind it early enough to fix it, and gives you something concrete to take to your next appointment. Blood work alongside the coaching runs through our partners at Orba Health, and anything medical goes to your doctor.

How to start

1. The 1% Scorecard. 8 questions, 2 minutes, free. You get a score out of 100 and the one thing to install first.
2. Stealth Coaching. Private 1:1 coaching, online or in person in Bangkok, working alongside your doctor’s plan. We install the habits, track them daily and review them every 28 days. It starts with a Stealth Strategy Call and has a 6-month minimum.

Book the appointment with your doctor first. Take the plan to them, and bring their numbers to me.

Related reading: The flow approach to nutrition: eat for performance without a diet, Nutrition coaching: what a coach does and what the evidence says and Infused water: 8 ideas and the tips that keep you hydrated.

FAQ

Sources

1. Riddle, M. C., Cefalu, W. T., Evans, P. H., et al. (2021). Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care, 44(10), 2438-2444. doi.org/10.2337/dci21-0034
2. Lean, M. E. J., Leslie, W. S., Barnes, A. C., et al. (2018). Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet, 391(10120), 541-551. doi.org/10.1016/S0140-6736(17)33102-1
3. Lean, M. E. J., Leslie, W. S., Barnes, A. C., et al. (2024). 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. The Lancet Diabetes & Endocrinology, 12(4), 233-246. doi.org/10.1016/S2213-8587(23)00385-6
4. Gregg, E. W., Chen, H., Wagenknecht, L. E., et al. (2012). Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA, 308(23), 2489-2496. doi.org/10.1001/jama.2012.67929
5. Diabetes UK. Type 2 diabetes remission and your medical team. Accessed October 2026. diabetes.org.uk
6. Goldenberg, J. Z., Day, A., Brinkworth, G. D., et al. (2021). Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data. BMJ, 372, m4743. doi.org/10.1136/bmj.m4743
7. Pavlou, V., Cienfuegos, S., Lin, S., et al. (2023). Effect of time-restricted eating on weight loss in adults with type 2 diabetes: a randomized clinical trial. JAMA Network Open, 6(10), e2339337. doi.org/10.1001/jamanetworkopen.2023.39337
8. Umpierre, D., Ribeiro, P. A. B., Kramer, C. K., et al. (2011). Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA, 305(17), 1790-1799. doi.org/10.1001/jama.2011.576

This article is general information, not medical advice.