Remission of Type 2 Diabetes: Many Paths to the Same Goal

The global prevalence of type 2 diabetes continues to rise inexorably, translating to millions of individuals at risk of developing debilitating and life-threatening vascular and metabolic complications (1). The current treatment paradigm for type 2 diabetes, aiming at restoring and maintaining euglycemia through a combination of lifestyle modification and pharmacotherapy, does not adequately attenuate this risk, particularly since individuals might have accumulated considerable magnitude and duration of hyperglycemia prior to diagnosis. Therefore, attention has recently been focused on inducing remission of type 2 diabetes, i.e., returning individuals to a state of euglycemia without ongoing need for glucose-lowering medications (2). Several approaches have been trialed to achieve this goal, including intensive lifestyle modification, pharmacotherapy, and surgery. Most evidence for the effectiveness of such programs comes from developed countries, with limited diversity of target populations, and little data exist on the benefits of multimodal pharmacotherapy interventions for type 2 diabetes remission.