The guide

Can type 2 diabetes be reversed?

By GyroscopeUpdated November 15, 20268 sources

For some people, yes, though doctors call it remission rather than a cure. An international panel defined remission in 2021 as an A1c under 6.5% (48 mmol/mol) measured at least 3 months after stopping glucose-lowering medicine. In the best-known trial, almost half of the people in a weight loss program reached it within a year, and the more weight they lost, the more likely they were to get there.

Why “reversed” causes arguments

Ads promise to “reverse diabetes” with a supplement or a diet. Doctors used to say type 2 only ever got worse. Both miss what the trials found.

Type 2 diabetes can go quiet. Blood sugar can come back under the diabetes line without medicine, and stay there for years. But the tendency doesn’t disappear, and it can come back, especially if the weight does. That’s why experts chose the word remission, and why the 2021 panel suggested keeping people in remission under active observation.

The DiRECT trial

Researchers in the UK ran the Diabetes Remission Clinical Trial in 49 general practices, with 306 adults who had type 2 diabetes. The practices were split into two groups. One group got usual care. In the other, people came off their diabetes medicines and replaced all their food with a formula diet of about 825 to 853 calories a day for 3 to 5 months. Then food came back step by step over 2 to 8 weeks, followed by a program to keep the weight off.

After a year, 46% of the program group were in remission, against 4% with usual care. They’d lost 10 kg (22 pounds) on average, against 1 kg.

The weight decided it. Of the 36 people who lost 15 kg or more, 31 were in remission, 86%. Nobody who gained weight got there.

Does it last?

At two years, 36% of the program group were still in remission. In the authors’ words, “Sustained remission was linked to the extent of sustained weight loss.” Among the people who kept at least 10 kg off, 64% were in remission.

Why weight loss can do it

A small UK study gives the clearest picture. 11 people with type 2 diabetes ate 600 calories a day for 8 weeks under supervision. Their fasting blood sugar went from 9.2 to 5.9 mmol/L (166 to 106 mg/dL) within a week, and the fat in their liver fell from 12.8% to 2.9% by week 8. The diet was extreme and the group tiny, but it shows what the bigger trial found: losing fat from the liver and pancreas lets them work again.

What about prediabetes?

Prediabetes goes back to normal more easily, and it’s the stage where the evidence is strongest. In the Diabetes Prevention Program, weight loss and walking cut new diabetes by 58% over 2.8 years. People whose blood sugar went back to normal even once had 56% lower diabetes risk later. The plan as the trial ran it is in how do I reverse prediabetes?, and each habit is sized in the habits that cut your type 2 risk.

Safety first

• Do it with your doctor. In DiRECT, the doctors stopped the medicines at the start. That’s a medical decision.
• Insulin and sulfonylureas cause lows when food drops. The ADA’s 2026 standards count under 70 mg/dL as low and under 54 as serious. In a trial of 41 adults with type 2 diabetes on glucose-lowering medicine, fasting days about doubled the rate of lows, even with the doses reduced.
• Keep testing. Remission needs an A1c at least yearly, since type 2 can come back.
• Not for everyone. If you’re pregnant or have had an eating disorder, a very low calorie plan isn’t the place to start.