Spontaneous remission of type 2 diabetes mellitus (T2DM) was uncommon and frequently followed by relapse in a large clinical cohort. A retrospective analysis published in Diabetes Therapy evaluated clinical characteristics and outcomes of individuals with T2DM who achieved remission without structured intervention.

Electronic medical records of 243,400 adults with T2DM treated at a tertiary care center in India between 1993 and 2018 were analyzed. Spontaneous remission was defined as achieving hemoglobin A1c (HbA1c) <6.5% for at least 3 months without glucose-lowering therapy in individuals who previously had HbA1c ≥6.5%. A matched group without remission was used for comparison.

A total of 275 individuals (0.11%) achieved spontaneous remission. Remission rates varied by baseline HbA1c, occurring in 0.34% of those with HbA1c <7.0%, 0.13% with HbA1c 7.0–7.9%, and 0.08% with HbA1c ≥8.0%.

Relapse occurred in 69%, 80%, and 87% of these groups, respectively, after a median remission duration of 2.1 years. Sustained remission was observed in 55 individuals (0.02%). Individuals achieving remission were older, had lower body weight and glucose levels, shorter diabetes duration, higher C-peptide levels, and greater physical activity. Relapse was more frequent in those with higher body weight and postprandial glucose levels, while longer remission duration was observed with greater weight loss.

Spontaneous remission in T2DM was rare and often transient, with higher baseline HbA1c associated with relapse and sustained weight loss linked to longer remission.