Abstract

Type 2 diabetes (T2D) is a chronic metabolic disorder traditionally regarded as progressive; however, growing 
evidence demonstrates that sustained remission is achievable through lifestyle interventions. Lifestyle-induced 
remission offers a non-pharmacological strategy to reduce diabetes-related morbidity and long-term healthcare 
burden. This narrative review synthesizes current evidence on lifestyle interventions associated with T2D 
remission, focusing on dietary modification, physical activity, behavioural and psychosocial determinants, and 
modes of intervention delivery. The review examines conceptual frameworks and definitions of remission, durable 
remission, relapse, and maintenance, alongside the biological and behavioural mechanisms underlying glycaemic 
normalization. Evidence from calorie restriction and weight-loss strategies, low-carbohydrate and ketogenic diets, 
and Mediterranean and plant-forward dietary patterns is evaluated, highlighting variability in remission rates and 
durability across interventions and populations. The role of physical activity including aerobic, resistance, and 
combined training is explored, with emphasis on metabolic improvements independent of weight loss and the 
importance of long-term adherence. Behavioural strategies such as motivational interviewing, self-management 
education, and structured support are identified as critical enablers of engagement, adherence, and remission 
maintenance. The review also addresses heterogeneity in patient response, safety and tolerability concerns, and 
challenges related to implementation and real-world applicability. Overall, lifestyle-induced remission of T2D is 
attainable, particularly when interventions are intensive, initiated early, and supported by behavioural and 
psychosocial frameworks. Future research should prioritize standardized remission definitions, long-term outcome 
evaluation, and scalable intervention models to support sustained remission in diverse populations.