01Why This Question Matters to 40 Million Americans

The CDC’s National Diabetes Statistics Report, updated in September 2026, estimates that 40.1 million people in the U.S., about 12% of the population, had diabetes in 2023. More than a quarter of adults with diabetes did not know they had it. Another 115.2 million adults have prediabetes, including more than half of Americans 65 and older.

Type 2 diabetes accounts for the vast majority of these cases; the CDC counts about 2.1 million Americans with type 1. Remission research applies only to type 2, in which the body still makes insulin but cannot use it well, often because of excess fat in the liver and pancreas.

02Remission, Not Cure: The Word Doctors Choose Carefully

An international expert group convened by the American Diabetes Association agreed in 2021 on a definition: remission is an HbA1c below 6.5%, or 48 mmol/mol, measured at least three months after stopping all glucose-lowering medication. Doctors avoid “cure” and “reversal” because the underlying tendency remains. If weight returns, blood sugar often follows.

Why Weight Loss Works

Researchers at Newcastle and Glasgow universities, who led DiRECT, argue that type 2 diabetes is driven largely by excess fat building up inside the liver and pancreas. Losing enough weight drains that fat, allowing the insulin-producing cells to recover. “Weight loss of 10-15kg (about 2 stones) is enough to remove that abnormal fat from vital organs,” said Professor Mike Lean of the University of Glasgow. The amount needed varies; people who are not heavy can still have fat in those organs.

03The Trial That Changed the Conversation

The DiRECT trial, published in The Lancet in 2018, enrolled 306 adults in the U.K. who had type 2 diabetes for up to six years and were not on insulin. Half were given a total diet replacement of about 830 calories a day for 12 weeks, using shakes and soups, followed by gradual food reintroduction and long-term support. The other half received usual care.

1. Weeks 1 to 12Diet replacementAbout 830 calories a day from shakes and soups; diabetes medicines stopped under supervision.
2. Weeks 13 to 18Food returnsGradual reintroduction of ordinary meals.
3. Months 4 to 24MaintenanceRegular check-ins to prevent weight regain.
4. Years 3 to 5Extension95 participants followed every 3 months.

That chart is the single most useful picture of remission. Small weight losses rarely did it. Losses above about 10 kilograms, or 22 pounds, made remission more likely than not. Newcastle University reported that among people in the diet group who lost more than 10 kilograms, 75% were in remission at both one and two years.

What Happened Over Five Years

The DiRECT extension study, published in 2024, followed 95 of the original participants for three more years. Overall remission among those with five-year data was 13%, and 26% of people in remission at two years were still in remission at five. Those who stayed in remission had kept off an average of 8.9 kilograms. “This five-year study demonstrates that long-term remission from type 2 diabetes is possible,” said Professor Roy Taylor of Newcastle University.

The diet group also had 4.8 serious health events requiring hospital admission per 100 patient-years, compared with 10.2 in the control group, less than half the rate. Taylor noted that benefit appeared whether or not people achieved remission.

04Real-World Results and the U.S. Evidence

England’s National Health Service turned DiRECT into a real-world program, the NHS Type 2 Diabetes Path to Remission Programme. Early results published in The Lancet Diabetes and Endocrinology in August 2024 covered 7,540 people referred. Among those who started the diet, 27% with enough data were in remission at one year. Among people who completed the program, 32% reached remission, with completers in remission losing an average of 16 kilograms.

In the U.S., the Look AHEAD trial tested an intensive lifestyle program combining calorie reduction and about 175 minutes of weekly exercise in more than 5,000 adults with type 2 diabetes. A 2012 analysis in JAMA found 11.5% achieved partial or complete remission in the first year and 7.3% at four years, compared with 2% in the control group. Look AHEAD participants had diabetes longer on average, and some used insulin, which helps explain the lower rates.

Where Exercise Fits

Exercise improves how muscles use glucose, lowers HbA1c and helps keep weight off, which is why it was part of both DiRECT’s maintenance phase and Look AHEAD. But exercise alone rarely produces enough weight loss for remission. The American Diabetes Association recommends at least 150 minutes of moderate to vigorous activity a week, resistance training two to three days a week and breaking up long periods of sitting. Think of exercise as the tool that protects remission once diet has achieved it.

05Who Has the Best Odds

Remission is not equally likely for everyone. Based on the trials above, these factors shape the chances. The zones are a general guide drawn from trial eligibility and results, not a personal prediction.

1. Talk to your doctor firstAsk whether remission is realistic for you and how your medicines would need to change during weight loss.
2. Get a baseline HbA1cKnow your starting point; remission is measured against the 6.5% threshold.
3. Choose a structured planSupervised low-calorie programs, meal replacements or a reduced-calorie Mediterranean-style diet can all work.
4. Aim for 10 to 15 kgThat range gave the best remission odds in DiRECT; any loss still helps.
5. Build activity toward 150 minutesAdd resistance training 2 to 3 times a week to protect muscle and blood sugar.
6. Plan for maintenanceWeight regain was the main reason remission ended; ongoing support matters.

Tracking Progress Between Lab Tests

HbA1c reflects about three months of blood sugar, so it changes slowly. Between tests, many people track weight weekly and, if their doctor recommends it, home glucose readings. A steady downward trend in weight is usually the earliest sign that a plan is working. If you take medicines that can cause low blood sugar, your care team may reduce or stop them as you lose weight, which is one reason regular contact matters during the first few months.

Expect plateaus. Weight loss often slows after the first phase, and remission can come and go as weight shifts. The DiRECT data suggest that people who held onto most of their weight loss were the ones who stayed in remission, so the long maintenance phase deserves as much planning as the diet itself.

What About Weight-Loss Drugs?

GLP-1 medicines such as semaglutide and tirzepatide can produce weight losses in the 10% to 20% range. Because they also lower blood sugar directly, people taking them are not in “remission” under the 2021 definition until the drug has been stopped for at least three months. Researchers are studying whether these medicines can help people reach and hold remission, but that evidence is still developing.

• HbA1c under 6.5%For 3 months off medicines
• Lose 10 to 15 kgBest odds in DiRECT
• Act within 6 yearsOf diagnosis if possible
• 150 minutes of activityPlus 2 to 3 strength days
• Medical supervisionEspecially on insulin
• Yearly checks continueEyes, feet, kidneys, HbA1c