Department of Research & Evaluation News

A diagnosis of Type 2 diabetes typically means a future of blood sugar monitoring and glucose-lowering medications. But interest is growing in identifying which people with diabetes might be able to stop taking their medications and control their disease with diet and exercise alone. A new Kaiser Permanente study, published in Diabetes Care, sheds light on the patients most likely to reach this goal.

“Type 2 diabetes affects more than 1 in 10 people in the United States, and it previously had been considered a lifelong progressive disease. But then we began to see people with bariatric surgery achieve diabetes remission. And could that be replicated through intensive program of diet and exercise?” said co-author Jaejin An, PhD, of Kaiser Permanente Southern California Department of Research & Evaluation. “So, in this study we examined the remission occurrence and characteristics of patients in a large, diverse cohort to uncover new insights into real-world diabetes management.”

The study is important because people with Type 2 diabetes are at increased risk of developing heart and blood vessel disease, nerve damage in their arms and legs, kidney disease, and a range of eye conditions, Dr. An added.

The study showed that Type 2 diabetes remission is rare without bariatric surgery, and is most likely for those patients who take fewer medications, have lower blood sugar levels, and have had diabetes for a shorter period of time.

Study included broad, diverse patient population

The study included patients within the Kaiser Permanente regions of Hawaii, Northern California, and Southern California, Geisinger in Pennsylvania, HealthPartners in Minnesota and Wisconsin, and Henry Ford Health in Michigan.

“Doctors and patients both want to know whether it is possible to determine which people with diabetes are most likely to experience remission and not need medication,” said senior author Luis A. Rodriguez, PhD, a research scientist at the Kaiser Permanente Division of Research in Northern California. “We know that patients with Type 2 diabetes who have bariatric surgery to treat obesity often go into remission. That’s why in our study we focused specifically on patients who did not have this surgery and who instead went into remission because of diet and lifestyle changes or medications that helped them lose some weight.”

Study findings show remission may be hard to sustain

The research team reviewed the electronic medical records of 556,758 adults with Type 2 diabetes receiving care from 2014 to 2023. They identified 16,016 adults (2.9%) who had their diabetes go into remission. However, the study found that for many people, remission was hard to sustain. Nearly 37% of the 16,016 adults who went into remission needed to go back on medication to control their diabetes over the following 3 years.

The researchers used the recently updated American Diabetes Association definition of remission as having a hemoglobin A1c (HbA1c) below 6.5% that persisted for 3 months or longer without use of glucose-lowering medications. HbA1c is a blood test that measures the average level of blood sugar over the past 3 months. A normal HbA1c is below 5.7%. If the HbA1c is between 5.7% and 6.4%, a person has prediabetes; an HbA1c of 6.5% or higher indicates diabetes.

Remission more likely for younger patients and the newly diagnosed

Younger adults, ages 18 to 29, had higher odds of remission compared to adults ages 75 or over. So did individuals diagnosed with diabetes less than a year earlier compared to those who had been diagnosed with diabetes 4 or more years earlier. Adults with a baseline hemoglobin A1c (HbA1c) less than 7% were more likely to go into remission than those whose baseline was 11% or higher at the start of the study. In addition, the adults taking multiple types of glucose-lowering drugs were significantly less likely to achieve remission than those taking less than 2 drugs.

“Our findings suggest that remission is more likely in adults with less severe disease,” said Rodriguez. “This would include those who have not had diabetes for a long time, have lower HbA1c levels, and are on fewer medications. These factors likely show that the body’s insulin-producing cells are working better and are responding more effectively.”

Weight-loss medication not associated with remission

Prior studies have found that people with Type 2 diabetes who have bariatric surgery often have their diabetes go into remission. However, the new study found that being on a GLP-1 receptor agonist, like liraglutide (Ozempic), was associated with decreased odds of going into remission.

“This may reflect the fact that these medications are often used by patients who have more complex or severe cases of diabetes,” said co-author Lisa Gilliam, MD, PhD, an endocrinologist with The Permanente Medical Group and a clinical leader for the Kaiser Permanente Northern California Diabetes Program.

More research is needed to understand whether outcomes for people with Type 2 diabetes who are able to stop their diabetes medications and control their diabetes with diet and exercise differ from outcomes for those who control their disease with medications or who have bariatric surgery.

Study shows that remission from Type 2 diabetes is possible

“This study shows that even outside of highly controlled interventions, remission is possible—especially for patients with less severe diabetes,” said co-author Julie Schmittdiel, PhD, associate director for Health Care Delivery and Policy at the Division of Research. “The next step is to learn whether achieving remission helps lower the risk of complications and improves overall health.”

Co-authors include Barune Thapa, SM, of the Kaiser Permanente Bernard J. Tyson School of Medicine; Romain Neugebauer, PhD, and Wendy Dyer, MS, of the Division of Research; David Arterburn, MD, MPH, of the Kaiser Permanente Washington Health Research Institute; Patrick J. O’Connor, MD, MA, MPH, Stephanie A. Hooker, PhD, MPH, Margaret B. Nolan, MD, MS, and Gregg Simonson, PhD, of HealthPartners Institute; Jaejin An, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation; Andrea E. Cassidy-Bushrow, PhD, of Henry Ford Health; Caryn E.S. Oshiro, PhD, RD, Kaiser Permanente Center for Integrated Health Care Research; Tainayah Thomas, PhD, MPH, of Stanford University; and Sarah Krahe Dombrowski, PharmD, of Geisinger.