What Is Diabetes Remission
Type 2 diabetes remission is a state where blood sugar levels return to normal without glucose-lowering medications. According to the American Diabetes Association criteria, remission is defined as HbA1c below 6.5% without medication for at least 3 months (Riddle MC, Diabetes Care 2021).
It is important to understand: remission is not the same as a complete cure. The predisposition to diabetes remains. However, under the right conditions, a person can live with normal blood sugar levels for decades.
Why Standard Treatment Doesn't Achieve Remission
The conventional approach to type 2 diabetes focuses on symptom management with medications. Metformin, glimepiride, insulin — they all lower blood sugar but don't address the root cause.
The root cause of type 2 diabetes is insulin resistance. Cells stop responding to insulin, the pancreas produces more and more of it, yet blood sugar remains elevated.
Some drugs stimulate insulin secretion, others lower blood sugar by other routes; none of them removes insulin resistance as such.
The md_pereligyn protocol: Addressing the Root Cause
Over 15 years of clinical practice, I developed a methodology aimed at eliminating insulin resistance. My own data are observational, have no control group and are unpublished, so I do not quote figures from my practice here. What published studies show about remission is set out under “The Evidence” below.
What the Protocol Consists Of
The Protocol includes three key components:
1. Insulin resistance diagnostics. Standard blood sugar and HbA1c tests are insufficient. We evaluate over 50 biomarkers: the HOMA-IR index most doctors skip, C-peptide, fasting insulin, inflammatory markers.
2. Personalized nutrition. Nutrition adjusted to the metabolic findings. In published studies, remission was more frequent the more weight people lost (see “The Evidence”).
3. Targeted nutraceuticals. Berberine, chromium, magnesium, alpha-lipoic acid — scientifically proven compounds that increase insulin sensitivity.
The Evidence
What published studies show:
- DiRECT (Lean ME, Lancet 2018; open-label, cluster-randomised): adults aged 20–65 diagnosed within the past 6 years, BMI 27–45, not on insulin; an 825–853 kcal/day formula diet for 3–5 months with diabetes drugs withdrawn, then stepped food reintroduction. Remission (HbA1c <6.5% at least 2 months off all diabetes drugs, the trial's definition) at 12 months: 46% (intention-to-treat); at 24 months: 36% (Lean MEJ, Lancet Diabetes Endocrinol 2019). Among those who lost 15 kg or more, remission was 86% (31 of 36), but they were only 24% of the intervention group
- Virta Health (Hallberg SJ, Diabetes Ther 2018; open-label, non-randomised, funded by Virta Health): supervised low-carbohydrate nutrition. Among the 204 participants with an HbA1c measured at 1 year, 60.3% had HbA1c below 6.5% on no diabetes medication or metformin only; this is not remission by ADA criteria, since metformin was allowed. 94% of insulin users reduced or eliminated insulin
- Berberine meta-analysis (Guo J, Oxid Med Cell Longev 2021): 46 RCTs, 4,158 participants with type 2 diabetes, berberine alone or added to standard therapy — HbA1c down by a mean 0.73%, plus lower fasting glucose, fasting insulin and HOMA-IR (−0.71). The analysis did not assess remission
None of these studies tested the protocol described above. In DiRECT, remission was more frequent the more weight people lost on the formula diet; in Virta, the intervention was low-carbohydrate nutrition. Both results come from selected groups and do not automatically apply to every patient.
Who Is the Protocol For
The methodology can be applied in type 2 diabetes, except in cases of complete pancreatic dysfunction (when C-peptide is near zero). The earlier treatment begins, the higher the chances of remission.
Published remission data come mainly from people diagnosed no more than 6 years ago, with excess weight and not on insulin (DiRECT); for longer-standing diabetes and insulin therapy the evidence is thinner.
Limitations: What I Don't Know
Intellectual honesty demands transparency:
- The protocol has not been tested in any published study; my observations are unpublished and uncontrolled
- Remission is not a cure — returning to old habits can bring diabetes back
The First Step Toward Remission
If you're asking "Can type 2 diabetes be cured?" — the honest answer is: not once and for all, but remission is possible for some patients. The first step is a consultation where we assess your situation and set realistic goals.
Remission is not a promise. The chances depend on how long you have had diabetes, how much pancreatic function remains, and how much weight you manage to lose.
