To the Editor: We note that the ADA/EASD consensus report on the definition of remission of type 2 diabetes is largely limited to a medical interpretation, focussing on physiological considerations and monitoring of biomedical indices [1]. As psychologists and behavioural scientists, we believe this consensus report would have benefitted from inclusion of a section highlighting that remission requires ongoing education, and behavioural and psychosocial support to manage expectations, enhance self-efficacy, minimise the potential for emotional distress or stigma, and to ensure sensitive and appropriate communication.

We recognise that the evidence for remission enables greater choice, self-efficacy and pro-active self-management from the time of diabetes diagnosis [2], with the possibility of a life free from diabetes-related complications. From a psychological perspective, this is important as it offers hope, which is notably the antithesis of depression [3], the occurrence of which is more common among people with type 2 diabetes than the general population and increases risk for diabetes-related complications [4].

However, several position statements around the world highlight that language matters in diabetes care [5]; so, we need to consider the broader implications of the language of remission beyond the medical interpretation. The consensus report proposes that ‘remission’ describes ‘a sustained metabolic improvement in [type 2 diabetes] to nearly normal levels’ [1]. While definitions of remission vary, all share the central notion of ‘release’. We believe that ‘remission’ is the correct language if it means that an individual has glycaemic levels in the range determined to mean a release from diabetes, without ongoing need for medication or maintenance of new health behaviours (e.g. diet, activity, sleep or stress management). However, this is not the case here; in the context of type 2 diabetes, achieving and sustaining remission requires multiple and complex long-term changes in health behaviours, thinking patterns and social behaviours [6, 7].

So, let us consider what this may mean to a person with type 2 diabetes; they have been through a period of intensive treatment (a ‘change of lifestyle, other medical or surgical interventions’ [1]) and their doctor declares that their diabetes is now ‘in remission’. Are they now cured? Is their diabetes gone forever? Do they now fear the recurrence of diabetes? Are they more or less distressed? What are the implications for their identity, or for the majority who cannot achieve or sustain remission? Attitudes about identity following cancer remission play a complex role in the individual’s longer-term outcomes [8]; this will be even more relevant in type 2 diabetes, where remission is reliant entirely on the individual’s behaviours.

Remission will not be a reality for most people for most of the time, and certainly not without considerable behavioural changes and psychosocial support [6, 7]. In the absence of evidence regarding the suitability of the term ‘remission’ in the context of type 2 diabetes, we do not propose an alternative term. However, we do encourage full consideration of the behavioural and psychosocial perspective of, and cautious messaging about remission in clinical practice and public health communications, in order to increase self-efficacy without creating false hope, feelings of failure or stigma for those who cannot achieve or sustain remission.