Diet and exercise put half of younger adults with type 2 diabetes into remission

Type 2 diabetes is often thought of as a condition of later life, but more people are being diagnosed in their twenties and thirties. Early-onset type 2 diabetes tends to progress faster than the later-onset kind, so researchers are keen to find treatments that work well and work early.

A trial published on 1 October in The Lancet Regional Health – Americas, and presented at the European Association for the Study of Diabetes meeting in Milan, tested one approach: a short, supervised low-calorie diet combined with structured exercise. The University of Leicester, which co-led the work with McGill University in Canada, described the results on 9 October.

What the researchers did

The trial, called RESET for Remission, ran at three centres in England and Canada. It recruited 96 adults aged 18 to 45 who had early-onset type 2 diabetes and obesity and weren’t using insulin. Their average age was 38 and their average starting weight was just over 100 kg.

Half were randomly assigned to usual care. The other half followed a programme with two phases:

• Weeks 1 to 12: a low-energy diet of 800 to 900 calories a day. For the first two weeks this was meal replacements only; after that, one ordinary meal a day was allowed, built around protein, fruit and vegetables. Alongside the diet came two supervised exercise sessions a week, mixing aerobic and resistance training, plus one session on their own.
• Weeks 13 to 24: a weight-maintenance diet with continued independent exercise.

Where appropriate, people in this group stopped their diabetes and blood pressure medicines under the study team’s supervision. Remission was defined as blood sugar (HbA1c) below the diabetes threshold of 48 mmol/mol, without glucose-lowering medication for at least 12 weeks.

What they found

After 24 weeks, 54% of people in the diet and exercise group were in remission, compared with 4% in the usual-care group. Nine in ten participants completed the study.

The intervention group lost an average of 7.5 kg more than the usual-care group, and most of that loss was fat. MRI scans showed muscle mass was preserved, and strength and fitness improved. The authors say this shows “muscle mass preservation is achievable with rapid weight loss”, which they put down to including resistance training during the strict diet phase.

There were side effects. Most people in the intervention group (43 of 50) reported at least one, compared with 6 of 46 in usual care. These were mainly early effects of the diet, such as constipation, headaches, dizziness and tiredness, and they settled. No severe adverse events were linked to the programme.

Our take

This is a well-designed randomised trial and the gap between the groups is large. Two points stand out for anyone who trains.

First, the exercise wasn’t an afterthought. Rapid weight loss usually costs some muscle, and keeping muscle matters for strength, everyday function and long-term health. Pairing a calorie deficit with resistance training and enough protein is a sensible principle at any scale, and this trial adds evidence that it works even during an aggressive diet.

Second, the context matters. This was a closely supervised medical programme. Participants had support from clinicians and dietitians, and their medicines were adjusted by the team. Diets as low as 800 calories a day aren’t a do-it-yourself project. The NHS advises that very low calorie diets should only be followed with medical supervision, and anyone taking diabetes medication could become unwell if they cut calories sharply without that support.

It’s also a short study. Twenty-four weeks tells us what can happen; it doesn’t tell us how many people stay in remission after two or five years. The authors say longer-term, real-world studies are needed, and they’re right.

What this means if you have type 2 diabetes

If you’re interested in remission, talk to your GP or diabetes team. They can tell you whether a structured programme is suitable for you and what support is available locally. Diabetes UK has a clear explainer on what remission means and how it’s measured.

If you’re simply training to stay healthy, the message is familiar and encouraging: regular strength work and cardio, plus a diet you can stick to, do more together than either does alone.