Prediabetes Remission Revisited

Dr Jedha, Host

Hello there, Dr Jedha here, and thanks for joining me for episode 118. Today we’re revisiting a topic that I covered previously, in episode 87, because the research in this area is starting to move forward quite quickly—and that topic is prediabetes remission.

When I first discussed prediabetes remission on the podcast, it was based on one of the early papers that really brought this concept into the academic conversation. Up until recently, the idea of remission was mainly discussed in relation to type 2 diabetes. In fact, it wasn’t until 2021 that global diabetes organizations formally recognized type 2 diabetes remission in their position statements. Prior to that, the assumption in medicine was that type 2 diabetes was a progressive condition that would inevitably worsen over time.

But as the research became impossible to ignore, that view changed. We now know that type 2 diabetes can go into remission under the right conditions.

Prediabetes, however, has historically been discussed in a completely different way. The focus has almost always been on prevention—preventing progression to type 2 diabetes. You’ll often see phrases like “risk reduction,” “management,” or “delaying diabetes.”

But remission? Returning to normal glucose regulation? That hasn’t really been the way the conversation has been framed.

Yet for many years now, this is exactly what we’ve been helping our members achieve. Getting blood glucose levels back into the normal range. Restoring normal metabolic function. In other words, reversing prediabetes.

What’s interesting is that the research community is now starting to catch up with that idea. Over the past couple of years, more studies have begun looking specifically at what happens when people move from prediabetes back to normal glucose regulation.

And the findings are becoming clearer. Achieving remission appears to do more than just improve a lab number. It seems to reflect deeper improvements in how the body regulates blood sugar and metabolism.

So in this episode, I want to revisit the topic of prediabetes remission and look at what the newer research is telling us. What are the real benefits of returning to normal glucose regulation? And what does that mean if you’ve been diagnosed with prediabetes?

Let’s start by briefly recapping what we actually mean when we talk about prediabetes remission.

Prediabetes occurs when blood glucose levels are higher than normal, but not high enough to meet the diagnostic criteria for type 2 diabetes. It represents an intermediate stage of dysregulated glucose metabolism. Blood sugar control has started to drift out of the normal range, but the condition has not yet progressed to diabetes.

When we talk about prediabetes remission, we’re talking about restoring normal glucose regulation.

In the research literature, remission is generally defined as returning to normal glucose levels across the standard diagnostic tests, without the use of glucose-lowering medications.

That means achieving:

A fasting blood glucose below 100 mg/dL, which is below 5.6 mmol/L.

A two-hour glucose level after an oral glucose tolerance test below 140 mg/dL, or below 7.8 mmol/L.

And an HbA1c level below 5.7 percent, which is below 39 mmol/mol.

When someone meets those criteria and maintains them without medication, their glucose regulation is considered to have returned to the normal range.

Now, I think it’s important to pause here for a moment, because this framing is quite different from how prediabetes is often discussed in clinical settings.

Most guidelines talk about preventing diabetes or reducing risk. But the concept of remission takes a different perspective. Instead of simply slowing progression, the goal becomes restoring the body’s normal metabolic balance.

And that’s an important distinction. Because if glucose regulation can return to normal, it suggests that the underlying metabolic dysfunction can improve as well.

So with that in mind, let’s look at what the newer research is telling us about the benefits of achieving prediabetes remission.

One of the most important findings emerging from the newer research is that achieving prediabetes remission, that is, returning to normal glucose levels, dramatically reduces the risk of developing type 2 diabetes by 75% or more, which is very encouraging and shows us that achieving remission is a powerful protective factor.

What’s particularly interesting is that historically weight loss has been the thing that’s encouraged in prediabetes, as it’s been assumed that achieving weight loss is the most important thing. Yes it can be helpful. But some research shows that even where people did not lose weight, when they returned to normal glucose levels their future risk of developing type 2 diabetes was still much lower.

This suggests that restoring normal glucose regulation itself is one of the most important factors for reducing diabetes risk, which of course makes perfect sense and it’s something we’ve been helping our members achieve for over a decade. Prediabetes remission should absolutely be your main goal. 

When it comes to weight, the type and location of body fat is important. In several studies, people who achieved prediabetes remission tended to show a healthier pattern of fat distribution. In particular, researchers observed less expansion of visceral fat. This is the deeper type of fat stored around the organs in the abdominal cavity. Visceral fat is metabolically active. It releases inflammatory molecules and fatty acids that can interfere with insulin signaling and contribute to insulin resistance. It is also strongly linked to fatty liver, elevated triglycerides, and worsening glucose regulation.

By contrast, subcutaneous fat—the fat stored just under the skin—is generally considered less harmful from a metabolic perspective. What researchers are seeing is that people who return to normal glucose regulation often store less fat in the harmful visceral compartment and relatively more in the subcutaneous compartment.

Another important insight from the newer research is that prediabetes remission reflects genuine improvements in how the body regulates blood sugar.

In other words, it’s not simply a case of a blood test number looking better for a short period of time. When people return to normal glucose regulation, researchers are seeing improvements in their underlying metabolism and the metabolic processes that control blood sugar.

For example, people who achieve remission tend to show better insulin sensitivity. That means the body’s cells respond more effectively to insulin, allowing glucose to move out of the bloodstream and into the cells where it can be used for energy.

Researchers are also seeing improvements in pancreatic beta-cell function. These are the cells in the pancreas responsible for producing insulin. When beta-cell function improves, the body can release insulin more appropriately in response to rising blood glucose levels.

Another interesting change that has been observed is improved responsiveness to hormones involved in glucose regulation after meals. These hormones help coordinate insulin release and help the body manage the rise in blood sugar that occurs after eating.

Taken together, these findings suggest that when someone achieves prediabetes remission, we’re not simply seeing a temporary improvement in glucose levels. We’re seeing signs that the metabolic systems responsible for regulating blood sugar are functioning more effectively again.

And that helps explain why returning to normal glucose regulation appears to have such a powerful effect on reducing future diabetes risk.

Another thing researchers are beginning to observe is that when people achieve prediabetes remission, improvements usually extend beyond blood glucose alone.

In lifestyle studies following people with prediabetes, people who return to normal glucose regulation often show improvements across a range of other cardiometabolic markers.

For example, fasting glucose and HbA1c typically improve, as you would expect. But researchers are also seeing improvements in insulin resistance, meaning the body is responding more effectively to insulin.

Blood pressure often improves as well, and lipid markers such as triglycerides and cholesterol levels frequently move in a healthier direction.

What this suggests is that remission tends to travel alongside broader metabolic improvements. Of course, none of this is new to me, as we know prediabetes doesn’t exist in isolation. It’s usually part of a cluster of changes that occur in the body’s metabolism that can include insulin resistance, altered cholesterol, elevated blood pressure, and changes in body fat distribution. But it’s good to see that the research is now connecting the dots. 

Being we have worked with thousands of members over the past decade, we know that when glucose regulation returns to normal, it often reflects improvements across multiple systems in the body, not just one isolated lab value. When glucose improves, so does blood pressure, cholesterol etc, because they are all connected. 

That’s an important point to understand. Achieving prediabetes remission is not simply about lowering one number on a blood test. It often represents a broader improvement in your overall metabolic health.

When we step back and look at the emerging research as a whole, a clear message is starting to come through.

Prediabetes remission offers substantial health benefits.

People who return to normal glucose regulation tend to have a much lower risk of developing type 2 diabetes in the future. They see improvements in insulin sensitivity and pancreatic function, healthier patterns of fat storage, and broader improvements in cardiometabolic markers such as blood pressure and blood lipids.

Taken together, these findings reinforce an important point.

Prediabetes should not simply be something that is monitored or managed. Where possible, the goal should be to restore normal glucose regulation.

That’s because returning blood glucose levels to the normal range reflects deeper improvements in how the body regulates metabolism. And those improvements can dramatically change a person’s long-term risk of developing type 2 diabetes.

Prediabetes represents a window of opportunity. It’s a stage where the imbalances that are occurring in the body that can lead to diabetes can often be corrected and reversed. 

So the conversation around prediabetes is starting to shift. Instead of simply focusing on delaying diabetes, the research is increasingly showing that returning to normal glucose regulation can meaningfully change a person’s metabolic trajectory. It can change their entire life and their future. 

Importantly, prediabetes is not a one-way pathway toward diabetes. The body’s metabolic systems are dynamic, and when the underlying drivers of dysregulated blood sugar are addressed, glucose regulation can return to the normal range. We see it time and time again with our members. 

And when that happens, we’re not just seeing a slightly better lab number. We’re seeing improvements in insulin sensitivity, pancreatic function, fat distribution, and broader cardiometabolic health factors like improved blood pressure, cholesterol, fatty liver, inflammation etc.

That’s why remission is such an important goal.

If you’ve been diagnosed with prediabetes, this stage gives you a powerful opportunity to intervene early and restore balance. The body has an amazing capacity to heal and restore itself when given the right input to do so. 

So, as always, if you’d like more guidance on improving blood sugar and restoring normal glucose regulation, head over to type2diabetestalk.com/programs and join us as a member.

It will be one of the best decisions you will ever make, because rather than guessing what to do, you’ll have a clear and proven pathway with ongoing support that will make achieving remission a whole lot easier. Hope to see you inside as a member!

Thanks for joining me today.

Dr Jedha, over and out.