Can you reverse type 2 diabetes?

What is diabetes remission?

Type 2 diabetes is diagnosed when your blood sugar levels exceed a normal range – usually a result of 48mmol/mol (6.5 per cent) or more on a HbA1c (glycated haemoglobin) test. If you have no symptoms, you may need a second test 2 weeks after the first to confirm the diagnosis.

Left to progress, type 2 diabetes can become a very serious disease with multiple debilitating complications, including cardiovascular disease (CVD).

But it is possible to reverse this disease process and put your blood sugar back in a healthy range by following a suitable diet plan and losing enough weight.

If you do this and your blood sugar level stays low enough for 3 months without needing to take medicine, it is known as diabetes remission.

Can you reverse type 2 diabetes permanently?

There is no guarantee that you will stay in remission forever. It is possible to develop diabetes again as you get older, especially if you have excess weight.

But research has shown it is possible to stay in diabetes remission for several years.

The DiRECT trial followed 188 people to see if changes to their diet could keep their diabetes into remission.

More than 80 per cent of participants who lost more than 15kg achieved remission for at least 2 years. And 13 per cent of participants who followed a dietary weight-loss programme, followed by supported weight loss maintenance, were able to maintain remission for at least 5 years.

Being in remission, even for a short time, has lasting benefits for your heart.

Being in remission brings lasting health benefits, no matter how long you achieve it for. It reduces the chance of developing diabetes-related complications, including heart attack, stroke and sight-loss.

The Look AHEAD study found that over a 12-year period, going into remission at any point was linked to a lower risk of heart and kidney complications, compared to never going into remission.

Not everyone will be able to reach remission, no matter what changes they make. It is also not possible if you have type 1 diabetes or monogenic diabetes, a rare inherited type of diabetes.

Can diabetes be reversed by weight loss?

Losing weight is key to reaching remission because you need to reduce the amount of visceral and ectopic fat, the harmful fat that builds up around and inside your vital organs, including the heart, liver, pancreas and skeletal muscle.

This fat interferes with the production of the sugar-regulating hormone insulin and also its effectiveness, known as insulin resistance, which allows your blood sugar to rise.

Your BMI (body mass index) is not always a clear indicator of your risk of type 2 diabetes because some of us are genetically predisposed to accumulate fat around the organs, despite being a healthy BMI.

This is why people from Black African, African Caribbean and South Asian backgrounds are at greater risk of developing type 2 diabetes from a young age.

It is easiest to achieve remission if you try to lose weight as soon as possible after diagnosis, and if you have a lower BMI.

You should aim for a 10 to 15kg (about 2st) weight loss, if you are living with excess weight or obesity, or around 10 per cent of your body weight.

About 10 per cent of people with type 2 diabetes in the UK – more in Asian communities – have a BMI below what is classed as overweight.

Research is ongoing into how they could put their diabetes into remission, but the ReTUNE trial in Newcastle found that a 7kg (1st) weight loss helped in 70 per cent of those cases.

Trials using different methods to lose weight and reach remission have found that a healthy diet is the most effective way, ideally supported by exercise. But exercise alone cannot achieve the type of fat loss needed.

Some people might need to use weight loss (bariatric) surgery or weight loss medications to support their diet changes.

Can you reverse diabetes through diet?

Different diets have been tested to see whether they can put type 2 diabetes into remission. The evidence so far shows that using a nutritionally balanced, very low-calorie diet is most effective.

Following successful clinical trials, the NHS offers people who meet the right criteria a 12-week supervised ‘soups and shakes’ meal replacement plan of 800 to 900 calories per day.

In England, this is known as NHS Type 2 Diabetes Path to Remission Programme. In Scotland and Wales, most health boards offer the diet through Counterweight Plus, while similar schemes are being trialled in Northern Ireland.

Not everyone is eligible for a diabetes remission programme and you will not be offered it if you have had a heart attack or stroke in the last 6 months, have heart or kidney failure, an active eating disorder, are using insulin or are having active treatment for cancer.

Losing weight in other ways will still have a positive impact on your diabetes and long-term health, whether you achieve remission or not. Options include following a Mediterranean diet, intermittent fasting or time-restricted eating, or an eating plan like the University of Glasgow No Doubts Diet.

Eating a healthy, balanced diet with plenty of vegetables and fruit, making healthy swaps and watching portion sizes is more likely to be sustainable in the long term.

The time taken to reverse diabetes with a very low calories diet will be individual to you but many people who achieve the weight loss needed did so within 2 to 3 months.

It is essential to consult a doctor before attempting this, as intensive diet changes require medical supervision. If you take any medicines for diabetes or high blood pressure, these may also need to be adjusted.

How do you stay in diabetes remission?

Diabetes remission can be difficult to maintain, particularly as you get older, when glucose control becomes increasingly hard.

The best approach is keeping your new weight stable, to prevent fat building up again, with long-term lifestyle changes.

In 2024, the DiRECT trial reported that those who stayed in remission for 5 years had an average maintained weight loss of 8.9kg (1st 5lbs).

If diabetes comes back, further weight loss may be needed. If you are not in remission, or are unable to stay in it, ensuring you eat a balanced diet and staying physically active will still help delay or slow down the progression of the disease.

This makes it easier to control the symptoms and reduces your need to take medicine.

Can you reverse prediabetes?

Prediabetes is when your blood sugar is higher than normal – between 42mmol/mol and 47mmol/mol on a HbA1c test.

This is not high enough to be classed as diabetes but most people will go on to develop type 2 diabetes. It also increases your risk of heart disease.

Prediabetes is estimated to affect 1 in 12 people and is more common in people who have excess weight or obesity.

Diabetes UK says losing weight and following a healthy lifestyle can reduce the risk of developing type 2 diabetes – and even reduce your blood sugar to a normal level

A recent study in The Lancet found that people who reverse prediabetes had a 58 per cent lower risk of death due to heart disease or being hospitalised with heart failure.

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