There can be cases where the glucose levels improve either spontaneously or after medical interventions in people with diabetes and in some cases can persist even after the withdrawal of glucose lowering therapy. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks vs. benefits of this glycemic attainment are not well understood. To update discussions of this issue, an international expert group including representatives from the American Diabetes Association, European Association for the Study of Diabetes, Diabetes UK, the Endocrine Society and the Diabetes Surgery Summit was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance.

According to the expert panel, glycaemic criteria for diagnosing remission of T2D include the following:

1. The term used to describe a sustained metabolic improvement in T2D to nearly normal levels should be remission of diabetes.
2. Remission should be defined as a return of HbA1c to <6.5% that occurs spontaneously or following an intervention and that persists for at least 3 months in the absence of usual glucose-lowering pharmacotherapy.
3. When HbA1c is determined to be an unreliable marker of chronic glycaemic control, FPG < 126 mg/dl or eA1C < 6.5% calculated from CGM values can be used as alternative criteria.
4. Testing of HbA1c to document a remission should be performed just prior to an intervention and no sooner than 3 months after initiation of the intervention and withdrawal of any glucose-lowering pharmacotherapy.
5. Subsequent testing to determine long-term maintenance of remission should be done at least yearly thereafter, together with the testing routinely recommended for potential complications of diabetes.
6. Research based on the terminology and definitions outlined in the present statement is needed to determine the frequency, duration and effects on short- and long-term medical outcomes of remissions of T2D using available interventions.