People with type 2 diabetes should be considered in remission if the blood glucose levels remain in the normal range for a period of 3 months or more. This was the consensus of experts from several international diabetes associations like the Endocrine Society, the European Association for the Study of Diabetes, Diabetes UK and the American Diabetes Association.

Advancements in treatment have led to improvements in blood glucose levels and a disease-free status. Different terminologies such as resolution, reversal, remission, and cure  have earlier been suggested for this. Since this improvement may not be permanent, experts have suggested that the term “remission” should be used instead. As per this newly published consensus statement, sustained metabolic improvement in type 2 diabetes to near normal levels should be called “remission”. Patients still need to be regularly monitored as hyperglycemia may return.

Glycemic criteria for remission of type 2 diabetes have also been defined by the experts; HbA1c has been proposed as the simplest and most widely understood measurement for glycemic control.

Type 2 diabetes is said to be in remission when HbA1c comes down to less than 6.5% either spontaneously or after an intervention and also persists for at least 3 months without the need for antihyperglycemic drugs. However, some factors such as a variant hemoglobin can affect estimation of HbA1c. Alternatively, fasting plasma glucose less than 126 mg/dL or eA1c less than 6.5% calculated from continuous glucose monitoring values can be used as the diagnostic criteria, when A1c values cannot be relied upon.

The interval before testing of HbA1c can reliably evaluate the response has also been suggested. HbA1c as a test for remission should be done at least 3 months after discontinuation of the antihyperglycemic drugs. Thereafter, HbA1c should be tested annually to determine sustained remission. This is accompanied by testing routinely recommended for potential complications of diabetes. 

The consent statement is published in the Journal of Clinical Endocrinology & Metabolism.

Source: Consensus report: definition and interpretation of remission in type 2 diabetes. The Journal of Clinical Endocrinology & Metabolism, https://doi.org/10.1210/clinem/dgab585; Endocrine Society News Release, August 30, 2021)