What criteria do the ADA Standards of Care—2026 use to define and recommend diabetes remission strategies?
Executive summary
The 2026 ADA Standards of Care adopt a pragmatic, evidence-rooted definition of type 2 diabetes remission based on sustained normal glycemia off glucose‑lowering therapy and pair this definition with actionable strategies—major sustained weight loss, intensive lifestyle programs, metabolic surgery, and use of potent weight‑loss–promoting GLP‑1/GLP‑1‑GIP agents—while flagging important uncertainties about long‑term outcomes and limits for type 1 disease [1] [2] [3] [4] [5] [6].
1. What counts as “remission”: a biochemical threshold with a time gate
The ADA-aligned international consensus recommends that type 2 diabetes be considered in remission when a person sustains normal blood glucose levels for three months or more after stopping diabetes medications, operationalized most commonly as an HbA1c <6.5% at least three months after cessation of glucose‑lowering therapy [1] [2].
2. Partial versus complete remission: shades of normal
Building on earlier consensus work, the Standards recognize gradations: partial remission has been defined in prior statements using HbA1c <6.5% and/or fasting plasma glucose in an intermediate range, while complete remission requires “normal” HbA1c and fasting glucose levels (for example, FPG <100 mg/dL), distinctions the ADA cites from consensus literature that inform clinical interpretation [2] [3].
3. The central role of weight loss: quantitative targets linked to outcomes
The 2026 guidance underscores that sustained weight loss is the dominant disease‑modifying strategy: modest losses (5–7%) improve glycemia and risk factors, but sustained loss of >10% of baseline weight usually confers greater benefits and is associated with possible remission of type 2 diabetes and improvements in long‑term cardiovascular outcomes and mortality [4] [5].
4. Proven paths to remission: lifestyle, surgery—and new drugs as facilitators
Intensive lifestyle interventions and metabolic (bariatric) surgery are explicitly recognized as routes to remission in the Standards, and the ADA highlights evidence that these approaches can produce remission in a sizable minority of people [3] [7]. The 2026 update also positions GLP‑1 receptor agonists and dual GLP‑1/GIP agents with higher weight‑loss potency (eg, semaglutide, tirzepatide) as recommended pharmacologic choices for people with type 2 diabetes who need weight reduction—thereby indirectly supporting remission‑oriented strategies by facilitating substantial weight loss [5] [8].
5. Who the Standards say this applies to — and who it doesn’t
The remission framework and recommended strategies are aimed primarily at people with type 2 diabetes; the ADA notes there are no approved therapies to preserve C‑peptide or prolong the honeymoon phase in established stage 3 type 1 diabetes, and teplizumab—approved for delaying progression from stage 2 to stage 3—is not indicated for established type 1 disease [6]. The 2026 Standards therefore treat remission as principally a type 2 clinical goal [3].
6. Caveats, evidence gaps, and conflicts of interest flagged by sources
The ADA and its international partners acknowledge uncertainty about the long‑term effects of remission on mortality, cardiovascular disease, and quality of life and call for more research into durability and outcomes of remission strategies [1] [2]. The consensus literature cited discloses authors’ relationships with industry, underscoring the need to read recommendations with awareness of potential competing interests [2].
7. How clinicians are advised to use the criteria in practice
The Standards integrate remission criteria into broader clinical algorithms: they recommend pre‑treatment evaluation, use of diagnostic thresholds for remission, and tailoring of interventions—lifestyle programs, referral for metabolic surgery where indicated, and selection of therapies (including GLP‑1/GIP agents) to support substantial, sustained weight loss—while emphasizing that these are evidence‑graded, living recommendations that will be updated as new data emerge [9] [7] [10].
8. Bottom line for policy and research
The ADA’s 2026 approach operationalizes remission with clear biochemical and temporal criteria and links those criteria to interventions that reliably produce large, sustained weight loss, but it explicitly leaves open critical questions about long‑term benefits, durability, and equitable access to intensive programs, surgery, and newer medications—areas the ADA and international collaborators identify as priorities for future study [1] [7] [4].