Abstract
OBJECTIVE: To assess the real-world frequency and characteristics associated with type 2 diabetes remission in a large and diverse cohort of U.S. adults. RESEARCH DESIGN AND METHODS: This retrospective cohort study used 2014-2023 electronic health record data from six major U.S. health care delivery systems. The cohort included 556,758 adults (≥18 years) with type 2 diabetes who had one or more HbA1c measurement in 2 years before study entry and evidence of glucose-lowering medication use. Pregnant women or adults who underwent bariatric surgery before or during the study were excluded. Type 2 diabetes remission was defined as HbA1c <6.5% persisting for ≥3 months after cessation of glucose-lowering medications. Multivariate logistic regression was used to identify characteristics associated with type 2 diabetes remission. RESULTS: Over a 3-year follow-up, 2.9% (16,016 adults) achieved type 2 diabetes remission, although 36.9% of those who experienced remission relapsed. The strongest characteristics associated with remission were not receiving glucose-lowering medications at baseline versus three or more medications (odds ratio [OR] 15.9, 95% CI 12.1-21.0), baseline HbA1c <7% vs. ≥11% (OR 3.1, 2.9-3.3) and diabetes duration <1 year versus ≥4 years (OR 2.6, 2.5-2.7). CONCLUSIONS: Type 2 diabetes remission was low among adults without bariatric surgery. The strongest associated characteristics were fewer diabetes medications, lower baseline HbA1c, and shorter diabetes duration. These findings highlight actionable factors to identify patients who may benefit most from targeted interventions. Future research should evaluate the long-term durability and health impacts of remission.