‘Sustaining Development Towards Remission’: A Constructivist Grounded Theory of Healthcare Professionals' Practice in Type 2 Diabetes Care

BACKGROUND: Type 2 diabetes remission is an achievable, evidence-based therapeutic goal, yet its integration into routine care remains at an early stage. In China, where leading institutions are pioneering remission-oriented practice, healthcare professionals play a pivotal role in shaping its clinical implementation. Nevertheless, how healthcare professionals perceive, interpret, and enact remission-oriented care remains understudied. AIM: To explore healthcare professionals' perceptions and experiences regarding type 2 diabetes remission implementation and to develop a constructivist grounded theory explaining how remission-oriented care is supported and advanced in clinical practice. DESIGN: A grounded theory study. METHODS: Using constructivist grounded theory methodology, we conducted semi-structured interviews between March and November 2025. Participants were recruited from healthcare settings that implemented type 2 diabetes remission services in Hunan Province, China, including tertiary hospitals, community hospitals, and healthcare companies. Coding proceeded through three iterative phases: initial coding, focused coding, and theoretical coding, combined with constant comparative methods and reflective memo-writing. FINDINGS: We recruited 23 healthcare professionals, including physicians, nurses, dietitians, and healthcare service managers. The core category of the substantive theory, 'sustaining development towards remission', captured the process of remission-oriented care from its conceptual introduction to clinical implementation. This process comprised four interrelated phases: germination, emergence, branching, and flourishing. The theory illustrates how healthcare professionals navigate cognitive adaptation and behavioural transformation in implementing remission-oriented care, highlighting the developmental trajectory of type 2 diabetes remission within routine diabetes management. CONCLUSIONS: The findings emphasise that achieving type 2 diabetes remission holds significant practical implications for promoting proactive health globally, while also representing a challenging process. It advocates that this approach be incorporated into routine diabetes care pathways to support remission-oriented management of type 2 diabetes, improve patient health outcomes, and optimise the professional contribution of nurses in sustainable diabetes management. IMPLICATIONS FOR THE PROFESSION: This study contributes to global understanding of remission-oriented diabetes care by illustrating healthcare professionals' implementation experiences and highlighting the contribution of nurses in supporting remission-oriented management of type 2 diabetes. REPORTING METHOD: The COREQ guidelines for qualitative research reporting were followed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.