Type 2 diabetes is not always a one-way street.

What does remission mean?

International experts define remission as an HbA1c below 48 mmol/mol, measured at least three months after stopping glucose-lowering medication. HbA1c is a blood test that reflects your average blood glucose over the past few months.

Remission is not a cure. Blood glucose can rise again. Regular check-ups and ongoing eye, kidney and foot care still matter, even when you feel well. Your healthcare team can help plan follow-up.

Medication is valuable treatment. Needing it is not a failure. Do not stop or change medication yourself to try to meet a definition.

What New Zealand research tells us.

Zinn, Schofield and colleagues explored primary care that combined carbohydrate reduction, health coaching and community or peer support.

Their 2024 qualitative study gathered patient and practitioner experiences. It described perceived improvements and barriers; it was not a trial proving that the approach causes remission.

Their 2025 retrospective audit reported improvements in some patients. It had no control group, so it cannot show what caused the changes or predict your result. The audit’s outcome should not be treated as equivalent to the international medication-free remission definition.

Food choices are one part of care. Cost, access, culture, medication and the support around you matter too. A clinician or dietitian can help you choose an approach that is safe and sustainable.

• Zinn C, Campbell JL, Po M, et al. (2024). Redefining Diabetes Care. Journal of Diabetes Research, 4843889. doi:10.1155/jdr/4843889
• Zinn C, Campbell JL, Fraser L, et al. (2025). Carbohydrate Reduction and a Holistic Model of Care in Diabetes Management. Nutrients 17(24):3953. doi:10.3390/nu17243953

Disclosure: the founder of maori.health works with members of the research team cited above. See About for our disclosures.

A way of eating that fits your life.

Whole-food, lower-carbohydrate eating is one option to discuss with your healthcare team. Other approaches can also help. What matters is finding something nourishing, affordable and sustainable for you, with support for the long term.

The DiRECT trial used a supervised low-energy meal-replacement programme, rather than testing carbohydrate restriction. At one year, 46% of the intervention group were in remission. In its five-year extension, 11 of 85 participants with follow-up data (13%) were in remission. These are different follow-up groups, not a prediction for you. Remission can be lost, and ongoing support matters.

The 2025 New Zealand audit followed 106 people with prediabetes or Type 2 diabetes across three practices. Its outcome criteria differ from the international definition of remission. It cannot establish that carbohydrate reduction alone caused the changes or that the same results apply to all Māori.

Support can include cooking with someone, help with transport, a dietitian or a Māori health provider. You choose who is involved. Better health and quality of life count, whether or not remission happens.

Before changing your eating: ask your prescribing clinician about medicine safety. Insulin and sulfonylureas can cause low blood glucose; very-low-carbohydrate eating or fasting can raise ketoacidosis risk with SGLT2 medicines such as empagliflozin. Do not stop or adjust medicines yourself.

• DiRECT original trial, Lean et al. (2018)
• DiRECT five-year follow-up, Lean et al. (2024)
• bpacnz: Type 2 diabetes management and medicine safety
• Healthify: choosing an eating approach