Re-evaluating the concept of remission in type 2 diabetes: a call for patient-centric approaches

Controlling weight and cardiovascular risk factors is paramount in type 2 diabetes management; however, the definition and feasibility of remission warrant closer examination. Type 2 diabetes remission, typically attained through weight loss, appears to be a temporary state based on the 2021 consensus definition, with most individuals experiencing weight regain and relapse of the condition. Although sustained type 2 diabetes remission is possible for some individuals and is associated with improved quality of life and reduced risk for microvascular and macrovascular complications, no conclusive evidence exists to show that achieving normoglycaemia and substantial weight loss without glucose-lowering medications is more beneficial than with them. Sustained control of hyperglycaemia, along with reducing adiposity-whether through surgical, medical, or lifestyle interventions-could be more relevant than remission itself. Herein, we assess current remission paradigms, emphasising the discordance among definitions and the need for approaches that better align with clinical realities and patient needs.