Key points

• In some patients with Type 2 Diabetes (T2D), glucose levels improve to normal or close to normal values.
• This improvement can occur spontaneously (rare) or after a change in lifestyle, pharmacological or surgical intervention.
• In some susceptible patients, a transient event of hyperglycemia may occur conditioned by temporary insulin resistance, precipitated by physiological factors such as pregnancy, glucocorticoid intake or acute illness. In most cases, when the precipitating event is resolved, glucose levels return to normal parameters; however, the risk of presenting T2D in the future remains.
• Correct term: Remission.
• In the vast majority of cases of remission, this is accompanied by loss (whether voluntary or involuntary) of body weight and adipose tissue.
• Definition of referral: a glycated hemoglobin (HbA1c) < 6.5% that persists for at least 3 months after discontinuation of hypoglycemic drug therapy. It is essential to have an HbA1c measurement prior to the intervention.
• Remission is considered a state in which T2D is not present, however, the patient must be kept under constant monitoring because it is not known when hyperglycemia may recur and/or present complications due to previous exposure. Mechanisms by which hyperglycemia could recur are weight gain, acute stress, continued decline in beta cell function.
• The patient in "remission" should be recommended to maintain a healthy lifestyle, with a meal plan and physical activity; with special interest in maintaining a healthy weight.
• The duration of remission and the long-term effects on the characteristic complications of T2D are still unknown.
• Target organ damage (eg, nephropathy) may be found in patients without a current diagnosis of diabetes who were chronically exposed to hyperglycemia in the past.
• After documentation of remission, check-ups should be performed annually along with the necessary revisions to prevent the classic complications of T2D (retinopathy, nephropathy, neuropathy, cardiovascular disease).