By HANA KAHLEOVA

“Will this only get worse?”

Patients with type 2 diabetes have asked me some version of that question for my entire career. For most of it, the honest answer was “probably.” We treated diabetes as a one-way street: glucose climbs, medications pile up, complications follow. Good care slowed the slope. It didn’t reverse it.

A year ago today, that assumption stopped being true, at least on paper. On October 1, 2025, CMS added E11.A, “type 2 diabetes mellitus in remission,” to the ICD-10-CM code set. To use it, a clinician has to document an HbA1c below 6.5% for at least three months after a patient has stopped all glucose-lowering medication. That’s the definition the American Diabetes Association, the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK agreed on in 2021. “Well controlled” doesn’t count. The code exists to separate remission from management.

That’s a real concession. When CMS creates a code for an outcome, it is saying the outcome is real, measurable, and common enough to track.

The evidence behind it isn’t new. In DiRECT, a cluster-randomized trial run through ordinary UK primary care practices, 46% of participants in a structured weight-management program were in remission after a year, compared with 4% on usual care. About a third were still in remission at two years. These weren’t patients at an elite research center. They came from routine general practices. That’s what makes the result a policy question, not a curiosity.

So here’s the policy question. One year in, what has the code changed?

As far as payment and quality measurement go, almost nothing.