What is type 2 diabetes? Can it go into remission?
In type 2 diabetes, insulin works less well and the pancreas can no longer make up for it: sugar stays too high in the blood, from 126 mg/dL fasting or an HbA1c of 6.5% (ADA, 2026). It can go into remission: 46% at 1 year in the DiRECT trial (Lean, 2018).
Schematic drawings, not to scale. Only the thresholds and study results are measured figures; drawn levels are labeled as such.
How does type 2 diabetes develop?
Insulin keys open the doors for sugar. Step by step, the locks resist and beta cells die. The steps play on their own, or use the arrows and numbers.
Sources: thresholds (ADA, 2026); years before diagnosis (Tabák, 2009); beta cells (Butler, 2003, 124 autopsies); prevention (Knowler, 2002); treatments over time (Turner, 1999); world figures (IDF, 2025). The drawn levels of insulin and beta cells are not measurements.
What does an HbA1c of 7% mean?
7% means that 7 out of 100 hemoglobins carry sugar. Move the slider: the drawing, the average glucose and the kidney follow.
Sources: thresholds and goal (ADA, 2026); average glucose (Nathan, 2008, 507 people, calculated from the formula); complications (Stratton, 2000, observational study: an association, not a promise); kidney threshold (to be verified).
Can type 2 diabetes go into remission?
Yes, for some people. Remission means an HbA1c below 6.5% at least 3 months after stopping medication (Riddle, 2021). It is not a cure: follow-up continues, because diabetes can come back. In the DiRECT trial, it depended mostly on the pounds lost. Choose a weight result at 1 year.
Sources: trial (Lean, 2018; 2019; 2024); liver and pancreas (Taylor, 2018); definition (Riddle, 2021). Remission at this pace requires medical follow-up.
Frequently asked questions about type 2 diabetes
What are the first signs of type 2 diabetes?
Most often, none. Worldwide, more than 4 in 10 people living with diabetes do not know it: 252 million of 589 million adults (IDF, 2025). The classic signs, when glucose is very high, are thirst, frequent urination and unexplained weight loss (ADA, 2026). Only a blood test can tell.
At what age should you get tested, and what are the thresholds?
The ADA recommends screening from age 35 for everyone, and earlier with overweight plus another risk factor, such as a close relative with diabetes or high blood pressure. If the result is normal, repeat at least every 3 years (ADA, 2026). Diabetes thresholds: 126 mg/dL fasting, an HbA1c of 6.5%, or 200 mg/dL 2 hours after the glucose test. Recommendations can differ by country: your doctor can tell you which apply.
Can you have type 2 diabetes without being overweight?
Yes. In the British UKPDS study, one person in three had a BMI under 25 at diagnosis (Taylor and Holman, 2015). According to these authors' “personal fat threshold” hypothesis, each person may have their own limit, with no direct link to BMI. Diabetes is therefore not a judgment on weight or willpower.
Does eating sugar cause diabetes?
Sugar is not the only cause, but sugary drinks are linked to the risk. One sugary drink a day is associated with a 13% higher risk, even at the same weight (Imamura, 2015). This is an observed association, not proof of cause. Weight, age, family history and lack of movement also count.
What medications are used?
The choice is made with your doctor, based on glucose, weight, heart and kidneys. A few reference points: metformin cut the risk of going from prediabetes to diabetes by 31% (Knowler, 2002). Empagliflozin, which sends sugar into the urine, cut cardiovascular deaths by 38% in people who already had heart disease (Zinman, 2015). Injectable GLP-1 type treatments lower HbA1c and weight: over 40 weeks, 1.86 points with semaglutide, up to 2.30 points with tirzepatide at the highest dose (Frías, 2021).
True or false?
Type 2 diabetes starts on the day of diagnosis.
False. Changes can be seen 3 to 6 years before diagnosis (Tabák, 2009).
You can have type 2 diabetes without being overweight.
True. In the UKPDS study, one person in three had a BMI under 25 at diagnosis (Taylor and Holman, 2015).
Remission means being cured for good.
False. In DiRECT, 46% were in remission at 1 year; at 5 years, 11 of the 85 people followed still were. Medical follow-up continues (Lean, 2018; 2024).
This page as text
The same information as the charts, to read without animation: for each chart, the values at the main moments, then the notes with their level of evidence.
What changes in the body in the 6 years before diagnosis?
Diabetes does not start on the day of diagnosis: insulin sensitivity falls first, the pancreas compensates, then glucose takes off. Shape based on Tabák, 2009; relative levels are drawn.
| Time | Insulin sensitivity | Insulin made | Fasting glucose | What happens |
|---|---|---|---|---|
| −6 yr | 76 | 50 | 8 | 6 years before diagnosis |
| −5 yr | 70 | 51 | 11 | 5 years before diagnosis |
| −4 yr | 59 | 54 | 14 | 4 years before diagnosis |
| −3 yr | 46 | 62 | 20 | 3 years before diagnosis |
| −2 yr | 33 | 48 | 34 | 2 years before diagnosis |
| −1 yr | 25 | 38 | 58 | 1 years before diagnosis |
| Diagnosis | 20 | 33 | 92 | The day of diagnosis |
Key points
- Sensitivity falls faster (From 5 years before until diagnosis, Shown in humans)
The decline speeds up in the last 5 years before diagnosis. Source: Tabák et al., “Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes,” Lancet, 2009 - The pancreas compensates (From 4 to 3 years before, Shown in humans)
Its output rises between 4 and 3 years before, then falls until diagnosis. Source: Tabák et al., “Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes,” Lancet, 2009 - Glucose takes off (From 3 years before until diagnosis, Shown in humans)
A slow rise, then a fast one starting about 3 years before diagnosis. Source: Tabák et al., “Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes,” Lancet, 2009 - A window to act (From 4 to 1 years before, Shown in humans)
Weight loss and movement cut the risk by 58% at the prediabetes stage. Source: Knowler et al., “Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin,” N Engl J Med, 2002
After a meal, how does blood glucose differ?
Two drawn examples. Without diabetes, glucose stays under 140 mg/dL 2 h after the meal and returns to its starting level in 2 to 3 h (IDF, 2011). With diabetes, it starts higher and comes down more slowly. The top of the chart is 300 mg/dL.
| Time | Without diabetes | With poorly controlled diabetes (example) | 126 mg/dL: fasting threshold (dotted) | 200 mg/dL: 2-hour threshold (dotted) | What happens |
|---|---|---|---|---|---|
| −30 min | 30 | 52 | 42 | 67 | 30 min before the meal |
| Meal | 30 | 52 | 42 | 67 | The meal |
| +1 h | 43 | 83 | 42 | 67 | 1 h after the meal |
| +2 h | 38 | 77 | 42 | 67 | 2 h after the meal |
| +3 h | 32 | 66 | 42 | 67 | 3 h after the meal |
| +4 h | 30 | 59 | 42 | 67 | 4 h after the meal |
| +5 h | 30 | 53 | 42 | 67 | 5 h after the meal |
Key points
- It starts higher (Before the meal, Shown in humans)
When fasting, the liver releases too much sugar. The diabetes threshold is 126 mg/dL. Source: American Diabetes Association, “Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2026,” Diabetes Care, 2026 - The 2-hour test (From 1 h 30 to 2 h 30 after the meal, Shown in humans)
After 75 g of glucose, 200 mg/dL or more at 2 h counts as diabetes, 140 to 199 mg/dL as prediabetes. Source: American Diabetes Association, “Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2026,” Diabetes Care, 2026 - Walking after a meal (From 0 min to 2 h after the meal, Shown in humans)
In 41 adults with type 2 diabetes, walking 10 minutes after each main meal gave a 12% smaller rise in sugar than 30 minutes all at once, and 22% smaller after the evening meal (calculated from published ratios). Source: Reynolds et al., “Advice to walk after meals is more effective for lowering postprandial glycaemia in type 2 diabetes,” Diabetologia, 2016
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