"Why do they say manage?" A Mixed-Method Exploration of Lifestyle-Driven Remission in Adults with Type 2 Diabetes

Type 2 diabetes (T2D) remission might be achievable through sustained lifestyle modifications, yet the lived experience of remission is understudied. This study explored the barriers to and facilitators of lifestyle-based remission in Canadians.

In this 2-phase mixed-methods study, quantitative data from 21 adults (57±8 years) who had achieved T2D remission were collected through questionnaires, glycated hemoglobin, and continuous glucose monitoring. A purposive subsample of 7 participants also completed semistructured interviews. Qualitative data underwent inductive thematic analysis and were integrated using meta-inference with a joint display approach.

Quantitative results showed strong glycemic regulation (24-h median continuous glucose monitoring glucose: 5.0 mmol/L [4.8 to 5.6 mmol/L]; 92.2% [85% to 97%] time in range), consistent physical activity, and good perceived health. Qualitative analysis identified 7 themes: 1) sustainable lifestyle strategies; 2) self-reliance; 3) commitment to remission; 4) individualised and supportive care; 5) health care, not medical care; 6) barriers inside and out; and 7) I would rather be healthy.

Integration highlighted informed decision-making, alongside psychosocial and educational factors, as central to sustaining T2D remission in naturalistic settings.