Challenging the Consensus Statement: Is It Time to Recognise Pharmacological Remission of Type 2 Diabetes?

Plasma glucose and HbA_1c concentrations below the diagnostic threshold for diabetes have been achieved in people with type 2 diabetes (T2DM) in three clinical settings: with intensive weight-management programs that induce > 10-15 kg bodyweight loss, following bariatric surgery, and during treatment with highly effective glucose- and weight-lowering medications. The current consensus definition of T2DM remission excludes a status of absence of diabetes achieved with concomitant use of glucose- and weight-lowering medications. However, since these treatments can safely achieve HbA_1c and plasma glucose concentrations lower than the ones currently used to define remission, we propose to consider a separate category of diabetes remission mainly achieved and maintained with pharmacological treatment. Our arguments are based on: (1) the similar endocrine mechanisms associated with bariatric surgery and use of GLP-1 receptor agonists or GIP/GLP-1 dual receptor agonists, (2) the lack of evidence that the effects of near-normoglycemic states achieved with lifestyle, surgery or glucose- and weight-lowering medications on long-term complications differ and (3) the frequent use of these medications in conjunction with both lifestyle interventions and following bariatric surgery. With this proposal, we aim to invite further discussion towards expanding the current narrow definition of T2D remission to include remission during treatment with newer highly effective glucose- and weight-lowering medications.