Shifting goals in type 2 diabetes management from glycemic control to disease remission: the potential role of traditional Chinese medicine and evidence challenges

The goals of type 2 diabetes mellitus (T2DM) management are gradually expanding from glycemic control alone to weight management, cardiorenal protection, and disease remission. Growing evidence suggests that, in some patients with a relatively short disease duration and preserved β-cell function, substantial and sustained weight loss and metabolic interventions can reduce ectopic fat in the liver and pancreas, improve insulin resistance, and promote the recovery of β-cell function, thereby achieving glycemic remission after discontinuation of glucose-lowering medications and indicating that T2DM may be reversible to some extent at specific stages. This narrative review summarizes the evolution of the concept of T2DM remission, its biological basis, the major approaches to achieving remission, and the key factors influencing remission, and on this basis re-examines the potential role of traditional Chinese medicine (TCM). Existing TCM research has primarily focused on improvements in metabolic indicators such as HbA1c, blood glucose, insulin resistance, and body weight, resulting in a clear “evidence–endpoint mismatch” with the evidentiary standards for remission, which center on sustained normoglycemia after medication withdrawal, duration of remission, and risk of relapse. However, direct evidence that TCM itself induces diabetes remission or modifies the established biological mechanisms of remission remains limited. Future studies should incorporate enrichment of populations with greater reversibility, standardized background treatment and medication reduction/discontinuation procedures, internationally harmonized remission endpoints, long-term follow-up, and high-quality randomized controlled trials. Imaging, multi-omics, mechanistic mediation analyses, and individualized treatment-effect prediction may further support the development of a modern remission-oriented evidence framework and help clarify the potential clinical value of TCM in T2DM remission and long-term disease management.