What “remission” actually means
Remission means the long-term blood sugar marker HbA1c stays in the non-diabetic range without glucose-lowering medication (usually below 6.5 % or 48 mmol/mol, for at least three months after stopping medication). The key distinction: remission is not a cure. The underlying predisposition remains and values can return, which is why regular check-ups are still needed.
What the DiRECT trial shows: even after five years
The UK DiRECT trial is the most important study on this. With a structured weight-management programme (first a very low-calorie formula diet, then gradual food reintroduction and support for keeping the weight off), 46 % achieved remission after one year and 36 % after two years.1
The five-year data put this in realistic perspective: after five years, 13 % of participants with available data were still in remission. Of those in remission at year two, around 26 % remained in remission at five years. It was common to regain weight and fall out of remission. Long-term remission is possible, but persists only for a portion of people: closely tied to maintaining weight loss.2
In DiRECT, the active ingredient wasn’t a particular diet but the substantial, maintained weight loss. What matters is the lasting result, and that is hard to maintain in everyday life.
Which paths exist
Besides structured weight programmes with a formula diet, bariatric-metabolic surgery can also lead to remission in pronounced obesity, well studied, but a procedure with its own risks. Which path is suitable depends on the individual situation and belongs in medical hands. In general: the shorter the diabetes has existed and the more weight is sustainably lost, the higher the chance.3
Medication is only reduced or stopped under medical supervision – never on your own. Even in remission, regular check-ups (blood sugar/HbA1c, eyes, kidneys, feet) remain important.
Key takeaways
- Remission = HbA1c in the non-diabetic range without medication – but not a cure.
- DiRECT: 46% (yr 1), 36% (yr 2), 13% (yr 5); ~26% of 2-year remitters stayed to year 5.
- Closely tied to sustained weight loss; relapses are common.
- No single diet leads to remission “reliably” – the maintained result is what counts.
- Bariatric-metabolic surgery is also a path; the choice is individual and medical.
- Check-ups remain necessary even in remission.
Article ID: SWF-W-022Please quote this ID for corrections or additions.
Sources
Sources as of: 21 Jul 2026.
- DiRECT: 46% remission after 1 year, 36% after 2 years; formula diet and weight maintenance. Lean et al., Lancet (2018/2019). thelancet.com (öffnet in neuem Fenster)
- DiRECT 5-year extension: 13% overall remission at year 5; 26% of 2-year remitters still in remission. Lancet (2024). thelancet.com (öffnet in neuem Fenster)
- Remission definition (HbA1c < 6.5% without medication, ≥ 3 months) and distinction from cure; bariatric-metabolic surgery. Consensus / ADA. diabetesjournals.org (öffnet in neuem Fenster)