Glycaemic remission in type 2 diabetes and subsequent microvascular and macrovascular outcomes: a systematic review and meta-analysis.

Abstract

Type 2 diabetes remission may reduce the long-term burden of vascular complications, but the magnitude and consistency of this association remain uncertain. We systematically evaluated whether remission was associated with lower subsequent microvascular and macrovascular or cardiovascular risk compared with non-remission. PubMed/MEDLINE and Europe PMC were searched through 31 August 2026 for longitudinal cohorts comparing adults with and without biochemical remission. Eight reports from seven independent cohorts were included, with five cohorts contributing to quantitative vascular synthesis. Remission was associated with lower microvascular risk (pooled HR 0.68, 95% CI 0.59-0.77; I² = 4.1%) and lower macrovascular or cardiovascular risk (pooled HR 0.73, 95% CI 0.61-0.87; I² = 8.7%). Findings were consistent across lifestyle, routine-care, and metabolic-surgery settings. Additional cohorts associated remission with lower all-cause and cardiovascular mortality. However, risk of bias was moderate or serious because remission was not randomized and may reflect favorable post-baseline risk-factor changes. Type 2 diabetes remission is associated with substantially fewer subsequent vascular events, but causal attribution remains uncertain. Remission should complement, rather than replace, continued complication surveillance and multifactorial risk management.