A new US diagnostic code recognises type 2 diabetes remission, but quality measures and reimbursement still favour lifelong treatment over the intensive support that can help patients achieve it.
A year after federal coders were told to recognise type 2 diabetes remission as a distinct clinical state, the American payment system still has little way to reward it. In October 2025, the Centres for Medicare and Medicaid Services added E11.A to the ICD-10-CM code set, creating a formal category for patients whose type 2 diabetes is in remission after at least three months off glucose-lowering medication and with an HbA1c below 6.5%. Diabetes UK said the change matters because it gives clinical language to something long argued by specialists: remission is possible, measurable and worth tracking.
That recognition, however, has not yet altered the machinery that shapes care. The code helps doctors document remission cleanly, but it does not create payment for the intensive support that often makes remission possible. Nor does it change the way performance systems judge health plans and medical groups. Measures used in programmes such as HEDIS, Medicare Advantage Star Ratings and MIPS still focus largely on whether patients meet glycaemic targets, not on whether they have moved out of the diabetes category altogether.
The gap matters because the evidence for remission is not theoretical. The DiRECT trial, conducted through ordinary primary care practices in the United Kingdom, found that 46% of patients in a structured weight-management programme were in remission after one year, compared with 4% receiving usual care. Two years on, about 36% of the intervention group remained in remission. Researchers and clinicians have pointed to the study as proof that, at least for some people early in the disease, structured intervention can reverse diabetes rather than merely slow it.
Yet the financing environment still pushes in the opposite direction. Medical nutrition therapy under Medicare remains tightly limited, and the programme’s best-known structured lifestyle benefit is aimed at preventing diabetes, not treating it after diagnosis. At the same time, the health-care system is absorbing rising spending on GLP-1 medicines, a class of drugs that can be highly effective and appropriate for many patients but also illustrates where the money is being directed. The result is a system that pays readily for long-term management while doing little to support time-limited, remission-focused care.
That imbalance has consequences for how clinics and health systems behave. If a patient reaches remission, the organisation may absorb the cost of an intensive programme without receiving any obvious credit in its quality scores. If the same patient remains on medication and continues to meet a target, the system is rewarded for ongoing treatment. Hana Kahleova, the article’s author, argues that the coding change should now be extended into quality measurement and payment design, so that remission is not merely recorded after the fact but actively supported. Her proposed fixes include adding remission to federal and private quality programmes, testing reimbursement for structured weight-loss and dietary interventions, and funding maintenance support to reduce relapse.
The case for doing so is not that every patient with type 2 diabetes can or should pursue remission. For many, especially later in the disease, medication remains the right and evidence-based path. But for those who are suitable candidates, the question is whether the system will offer remission as a realistic goal rather than a clinical curiosity. More than 38 million Americans have diabetes, most of them type 2. The coding now exists to say when the disease is in remission; the challenge is whether payment policy will ever catch up.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
