TY - JOUR
AU - S. Corrao
AU - F. Falcone
AU - L. Mirarchi
AU - S. Amodeo
AU - L. Calvo
A1 - 
AB - Type 2 diabetes mellitus (T2DM) is a global health priority, with an estimated 629 million people projected to be affected by the year 2045. T2DM significantly increases the risk of atherosclerotic cardiovascular disease and other complications. Hyperglycaemia imprints early molecular and cellular changes, often termed "metabolic memory", predisposing individuals to long-term microvascular and macrovascular complications, even after glycaemic normalisation. T2DM remission is increasingly recognised as an achievable target, offering substantial benefits such as reduced morbidity, improved quality of life, and preservation of beta-cell function. Among therapeutic options, metabolic surgery (MS) demonstrates the most significant impact, particularly for long-term outcomes. MS induces profound hormonal changes, including increased glucagon-like peptide 1 (GLP-1) levels and improved bile acid metabolism, alongside reductions in ectopic fat in the liver and pancreas, which improve insulin sensitivity and secretion. However, intensive lifestyle and pharmacological interventions, such as GLP-1 receptor agonists and glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 dual agonists like tirzepatide, also show promise, particularly when implemented early in the disease course. Predictors of sustained remission include younger age, shorter diabetes duration, lower baseline HbA1c, absence of insulin use, fewer medications and greater total weight loss percentage. Emerging tools such as the DiaRem score, machine learning models, and biomarkers like FGF-21 enhance patient stratification and predict remission likelihood. This narrative review explores the mechanisms and therapeutic options for T2DM remission, evaluates their impact on long-term outcomes and highlights the importance of early, multidisciplinary, and personalised interventions to optimize remission and improve metabolic health.
AD - Department of Clinical Medicine, UOC Medicina Interna iGR, Internal Medicine Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Piazza Nicola Leotta, 2, 90127, Palermo, Italy. salvatore.corrao@unipa.it.; Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties [PROMISE], University of Palermo, Palermo, Italy. salvatore.corrao@unipa.it.; Department of Clinical Medicine, UOC Medicina Interna iGR, Internal Medicine Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Piazza Nicola Leotta, 2, 90127, Palermo, Italy.; Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties [PROMISE], University of Palermo, Palermo, Italy.
AN - 40512404
BT - Diabetes Ther
C5 - Healthcare Disparities; Education & Workforce
CP - 8
DA - Aug
DO - 10.1007/s13300-025-01761-4
DP - NLM
ET - 20250613
IS - 8
JF - Diabetes Ther
LA - eng
N2 - Type 2 diabetes mellitus (T2DM) is a global health priority, with an estimated 629 million people projected to be affected by the year 2045. T2DM significantly increases the risk of atherosclerotic cardiovascular disease and other complications. Hyperglycaemia imprints early molecular and cellular changes, often termed "metabolic memory", predisposing individuals to long-term microvascular and macrovascular complications, even after glycaemic normalisation. T2DM remission is increasingly recognised as an achievable target, offering substantial benefits such as reduced morbidity, improved quality of life, and preservation of beta-cell function. Among therapeutic options, metabolic surgery (MS) demonstrates the most significant impact, particularly for long-term outcomes. MS induces profound hormonal changes, including increased glucagon-like peptide 1 (GLP-1) levels and improved bile acid metabolism, alongside reductions in ectopic fat in the liver and pancreas, which improve insulin sensitivity and secretion. However, intensive lifestyle and pharmacological interventions, such as GLP-1 receptor agonists and glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 dual agonists like tirzepatide, also show promise, particularly when implemented early in the disease course. Predictors of sustained remission include younger age, shorter diabetes duration, lower baseline HbA1c, absence of insulin use, fewer medications and greater total weight loss percentage. Emerging tools such as the DiaRem score, machine learning models, and biomarkers like FGF-21 enhance patient stratification and predict remission likelihood. This narrative review explores the mechanisms and therapeutic options for T2DM remission, evaluates their impact on long-term outcomes and highlights the importance of early, multidisciplinary, and personalised interventions to optimize remission and improve metabolic health.
PY - 2025
SN - 1869-6953 (Print); 1869-6961
SP - 1557
EP - 1579+
ST - Type 2 Diabetes Mellitus Remission, Dream or Reality? A Narrative Review of Current Evidence and Integrated Care Strategies
T1 - Type 2 Diabetes Mellitus Remission, Dream or Reality? A Narrative Review of Current Evidence and Integrated Care Strategies
T2 - Diabetes Ther
TI - Type 2 Diabetes Mellitus Remission, Dream or Reality? A Narrative Review of Current Evidence and Integrated Care Strategies
U1 - Healthcare Disparities; Education & Workforce
U3 - 10.1007/s13300-025-01761-4
VL - 16
VO - 1869-6953 (Print); 1869-6961
Y1 - 2025
ER -