I was a resident physician in New York City when I met a Jamaican woman in her early 40s, newly diagnosed with type 2 diabetes. The hospital was always crowded and the schedules unpredictable, making continuity difficult. But appointment after appointment, she found her way back to me. She trusted me and even brought me gifts on holidays.
Her hemoglobin A1c was 7.2. She had mild obesity, and no major complications. Still, I carried the certainty that medical training had provided me: type 2 diabetes was a chronic, progressive disease that you could only hope to manage over time. When she asked whether she could ever get rid of her disease, I sadly told her no. She began to cry.
Eighteen years later, I know I failed her. Not through neglect, but because of the limits of what medicine had taught me to believe. Today, I know differently. And that is why I believe it is time to change the clinical goal of type 2 diabetes treatment from managing disease to actively pursuing remission whenever possible.
The evidence for reversing type 2 diabetes
The long-held concept of type 2 diabetes as a one-way path shapes how clinicians counsel patients, how health systems allocate resources, and how patients view their futures. We now have evidence that intensive therapeutic lifestyle change, including optimal nutrition, regular physical activity, restorative sleep, and stress management, can not only improve blood glucose control but, in some cases, even put into remission the underlying metabolic dysfunction that drives the disease.
Dietary patterns centered on whole, minimally processed, plant-predominant foods have been shown to significantly improve glycemic control, sometimes to the point where patients no longer need diabetic medications nor meet diagnostic criteria for having diabetes. In structured programs, patients have achieved remission without extreme calorie restriction or reliance on liquid diets.
In 2025, a meaningful shift occurred when doctors were given a new medical billing code to use for type 2 diabetes in remission. This development signaled that remission is not an outlier but a legitimate clinical outcome that can and should be documented, measured, and pursued. This is important because more than 40 million Americans, or about 12 percent of the population, are living with diabetes, and another 115 million have prediabetes. Diabetes now costs the U.S. an estimated $413 billion each year in direct medical spending and lost productivity.
Elevating lifestyle interventions as first-line treatment
None of this dismisses the value of medications or procedures. Pharmacotherapy and bariatric surgery remain important and sometimes life-saving, but they should not be the default treatment plan. If lifestyle interventions, supported, sufficiently intensive, and paired with careful medication adjustment, can produce comparable outcomes without the risks and costs of invasive procedures, they should be elevated to first-line treatment. Project Remission, a recent national film series, highlights how some health systems and health professionals are already using evidence-based lifestyle interventions to treat type 2 diabetes and pursue remission.
This approach requires rethinking how we train and support clinicians. A barrier to embracing remission as a goal is the challenge of implementation. How do you help patients make and sustain meaningful behavior change? How do you safely reduce medications as glucose levels improve?
Clinical guidance now provides structured tools for behavior assessment, coaching, and deprescribing. Protocols for medication reduction are critical because, as patients improve, failure to adjust therapy can lead to hypoglycemia. However, if done appropriately, deprescribing becomes a sign of success.
Had I known all of this years ago, I would have answered my patient differently. Instead of false certainty about an inevitable decline, I would have told her: “Yes, this is serious, but not hopeless. There is more than one path forward, and remission may be possible.”
Mahima Gulati is an endocrinologist.
