"Why do they say manage?" A Mixed Method Exploration of Lifestyle-Driven Remission in Type 2 Diabetes.

OBJECTIVE: Type 2 diabetes (T2D) remission might be achievable through sustained lifestyle modifications, yet lived experience of remission is understudied. This study explored the barriers and facilitators to lifestyle-based remission in Canadians. METHODS: In this two-phase mixed methods study, quantitative data from 21 adults (57±8 years) who had achieved T2D remission were collected through questionnaires, HbA1c, and continuous glucose monitoring (CGM). A purposive sub-sample of 7 participants also completed semi-structured interviews. Qualitative data underwent inductive thematic analysis and were integrated using meta-inference with joint display approach. RESULTS: Quantitative results showed strong glycemic regulation (24hr median CGM glucose: 5.0 [4.8-5.6] mmol/L; 92.2 [85-97] % time in range), consistent physical activity, and good perceived health. Qualitative analysis identified seven themes: i) sustainable lifestyle strategies; ii) self-reliance: iii) commitment to Remission; iv) individualized and supportive Care; v) healthcare, not medical care; vi) barriers inside and out; and vii) I'd rather be healthy. CONCLUSION: Integration highlighted informed decision-making, alongside psychosocial and educational factors as central to sustaining T2D remission in naturalistic settings.