“Remission” is the best word to use when someone with type 2 diabetes sees signs of the disease go away due to lifestyle changes or bariatric surgery, according to a consensus statement from leading U.S. and international diabetes organizations, published in the journal Diabetologia.
The groups settled on this term because it signifies that while disease may not currently be present, it could return in the future. Alternative terms, on the other hand — like “cure,” “reversal,” or “resolution” — imply that a person will no longer have to deal with diabetes in the future, the authors of the report wrote. These authors included representatives of the American Diabetes Association, the European Association for the Study of Diabetes, Diabetes UK, the Endocrine Society, and the Diabetes Surgery Summit.
“Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy,” the authors wrote. “Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established.”
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Proposed criteria for diabetes remission
In addition to weighing in on the terminology, the authors proposed criteria for achieving diabetes remission. They include a single ideal standard for remission — an A1C level (a measure of long-term blood glucose control) below 6.5%, maintained for at least three months, without taking any glucose-lowering drugs (including insulin). Based on this standard, remission may occur spontaneously — without any known underlying explanation — or due to an intervention, such as weight loss, a dietary change, or bariatric surgery.
The proposed criteria also include alternative ways to define diabetes remission, in case A1C testing isn’t available for some reason. It can also be based on a fasting blood glucose level below 126 mg/dl, as shown by using a continuous glucose monitoring (CGM) system. But this approach requires using such a system, which may not be practical in many cases, and also may involve looking at multiple readings that are both above and below 126 mg/dl. So the authors highly recommend using an A1C level below 6.5% to define remission, writing that this test is “generally reliable and the simplest and most widely understood defining criterion under usual circumstances.”
The authors also noted that in some cases, simply using a glucose-lowering drug for a period of time may lead to diabetes remission — even after someone stops using that drug. But since many glucose-lowering drugs can have other important benefits — such as weight loss for metformin, or kidney protection for SGLT2 inhibitors — it may not be advisable to stop taking these drugs even if they may no longer be needed for blood glucose control. “If such considerations preclude stopping these drugs, then remission cannot be diagnosed even though nearly normal glycemic levels are maintained,” they wrote. “A clinical decision may be made to continue such therapies without testing for remission, and in that case, whether a true remission has been attained remains unknown.”
So while it may be possible to confirm diabetes remission by stopping a medication in some cases, that doesn’t mean it’s a good idea. Ultimately, the goal shouldn’t be an abstract goal like remission — it should be maintaining the best possible health through whatever lifestyle, surgical, or medication-based measures allow that to happen.