Hemoglobin A1c (HbA1c) is below 6.5%, and some people's blood sugar has miraculously returned to normal. Is this an ultimate victory, or a long-term battle that requires vigilance?

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In 2021, global leading professional organizations, including the American Diabetes Association, jointly issued a landmark consensus report. For the first time, it provided a clear definition for the "remission" of type 2 diabetes: Hemoglobin A1c (HbA1c) remains below 6.5% for at least three months after discontinuing glucose-lowering medication.

Data shows that through intensive lifestyle interventions, some newly diagnosed patients with type 2 diabetes can achieve remission. In some studies, the remission rate within one year can even exceed 10%.

01 Clarifying Concepts: "Reversal" is an Ideal, "Remission" is the Scientific Reality

When they see their blood glucose indicators return to normal, many people become excited and believe that diabetes has been "reversed" or "cured." However, the choice of medical terminology reflects a rigorous scientific approach.

The term "reversal" can easily be misinterpreted as the disease being completely eradicated, with the body returning to a state of perfect health. In contrast, the concept of "remission," borrowed from the management of chronic diseases such as tumors, refers to a significant reduction or disappearance of the signs and symptoms of the disease, while the "root cause" or susceptibility to the disease has not completely vanished.

The reason authoritative institutions insist on using "remission" is to avoid a critical misunderstanding: leading patients to mistakenly believe they can rest easy and no longer need to monitor their condition or adhere to a healthy lifestyle.

It is like a section of a dam developing a leak (diagnosis of diabetes). Through intensive repairs (intensive treatment), the leak is plugged, and the water level returns to normal (blood glucose levels are within the target range). However, the dam's structure has already been damaged (impaired pancreatic islet function). In the future, continuous maintenance (healthy living and monitoring) is still required; otherwise, during heavy rainfall (stress, unhealthy diet), there remains a possibility of the dam being at risk again.

02 Core Mechanism: Why "Remission"? What Happens in the Body?

To understand why it is "remission," we need to look at what the body has experienced at the time of diagnosis.

When diagnosed with type 2 diabetes, the patient's pancreatic beta cell function is typically significantly impaired, and the number of these cells may also be reduced. At the same time, the sensitivity of the liver, muscle, and adipose tissues to insulin is severely diminished (insulin resistance).

Current medical approaches can significantly restore insulin sensitivity and partially recover beta cell function through weight loss and metabolic improvements, thereby rebalancing the sources and utilization of blood glucose. However, those beta cells that have already been lost or functionally depleted are largely irreplaceable.

Therefore, "remission" is more akin to an excellent management of the body's metabolic state rather than a complete reconstruction of tissue structure. It signifies that the disease progression is effectively "paused" or "suppressed," but not "reset to zero."

03 Pathways to Achievement: Major Routes to "Remission"

According to international consensus and clinical practice, achieving remission of type 2 diabetes primarily involves the following core methods, often with multiple approaches working in combination:

First, intensive lifestyle intervention is the cornerstone of the foundation. Among these, scientific weight loss is recognized as the most effective strategy. Particularly for overweight and obese individuals with type 2 diabetes, guided by a healthcare professional, achieving and maintaining significant weight reduction (typically recommended as 10–15 kg or more than 10% of initial body weight) through calorie restriction (such as low-calorie diets, low-carbohydrate diets, etc.) is key to inducing remission.

Second, metabolic surgery is a potent approach for patients with severe obesity. For patients with a higher body mass index (BMI), metabolic surgery (such as gastric bypass or sleeve gastrectomy) can yield the most significant and durable remission rates. The surgery induces profound effects at neural, hormonal, and metabolic levels by altering gastrointestinal anatomy, but it carries strict indications and risks, requiring careful evaluation.

Furthermore, early intensive drug therapy offers another viable option. In newly diagnosed patients or those with a short disease duration, short-term (e.g., 2–3 months) use of intensive insulin therapy or certain new medications can help β-cells "rest" and rapidly alleviate glucotoxicity. This approach sometimes creates a favorable "time window" for subsequent lifestyle interventions and remission.

It is worth emphasizing that these methods are by no means isolated. The most successful approach is often one guided by a professional team (doctors, nutritionists, health management specialists), combining medical nutrition therapy, regular exercise, behavioral support, and necessary medications to form a personalized comprehensive management plan.

04 Ongoing Management: "Remission" is not a permanent solution

Achieving remission is a glorious victory, but it is by no means the end. Maintaining the "remission" state over the long term is a new, equally important, and enduring battle.

Continuous monitoring is essential. Even with normal blood sugar levels, it is important to follow medical advice and regularly check indicators such as HbA1c and fasting blood glucose, ideally at least once a year. This is akin to regularly inspecting a dam to detect even the slightest signs of abnormality in a timely manner.

Maintaining a healthy lifestyle is essential. It is the lifeline for sustaining remission. If dietary control and physical exercise slacken, leading to weight regain, high blood sugar will almost inevitably return. Healthy habits need to be internalized as a persistent way of life.

Screening for complications must be maintained. Diabetes remission primarily targets high blood glucose levels, but metabolic issues such as hypertension and dyslipidemia, as well as the potential impacts on the heart, eyes, kidneys, and feet, still require continuous attention and management.

When an obese patient with type 2 diabetes loses over 15% of their body weight through intensive lifestyle interventions and maintains it for more than a year, their blood sugar, blood pressure, and lipid levels often improve comprehensively—sometimes even allowing them to discontinue all glucose-lowering medications. This is undoubtedly a "metabolic miracle" achieved through the joint efforts of medicine and the patient.

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However, behind this miracle lies the biological reality that pancreatic β-cells, while given respite, cannot turn back the clock, and the truth that the body’s metabolic balance remains fragile. Remission is a hard-won truce, not the end of the war forever. ♂️