Intensive diet and exercise put more than half of younger adults with type 2 diabetes into remission

In a 96-person trial, 27 of 50 participants aged 18 to 45 achieved remission after six months of a very low-calorie diet and supervised exercise, compared with two receiving standard care.

A structured programme of very low energy intake and supervised exercise may offer a meaningful route to remission for younger adults with type 2 diabetes, according to new trial results presented at the Annual Meeting of the European Association for the Study of Diabetes and published in The Lancet Regional Health-Americas. In the RESET for Remission trial, just over half of participants assigned to the intensive lifestyle plan achieved remission within 24 weeks, compared with a small minority receiving standard care.

The study focused on early-onset type 2 diabetes, defined here as diagnosis before the age of 45, a form of the disease that researchers say tends to progress more quickly and brings a heavier burden of complications over a lifetime. That makes the findings potentially important for a group that often faces many decades of exposure to raised blood sugar, with knock-on risks for heart disease, kidney problems and other serious outcomes.

Researchers from McGill University, the University of Leicester and the University of Alberta randomised 96 adults aged 18 to 45 across three centres in England and Canada. The intervention combined an 800-to-900-calorie diet with supervised aerobic and resistance exercise, followed by a weight-maintenance phase and continued exercise. According to the trial report, 27 of 50 people in the intensive arm met the study definition of remission after six months, compared with two of 46 in the usual-care group.

The remission threshold required an HbA1c level below 6.5% and no glucose-lowering medication for at least 12 weeks. The researchers also tracked weight, body composition, fitness and heart-related measures. Participants in the lifestyle group lost substantially more weight than those receiving routine care, and much of the difference reflected fat loss rather than overall tissue loss, an important point in a condition where preserving muscle is increasingly seen as part of long-term metabolic health.

The study also reported that the intervention was not without drawbacks. Side effects were more common in the intensive arm, particularly early in the diet phase, and included constipation, headaches, dizziness and fatigue. However, no severe adverse events were reported, and the authors say the symptoms generally settled. They also argue that resistance training may have helped protect muscle during rapid weight loss, an issue that could matter if remission programmes are to be repeated or sustained outside a closely monitored trial.

The researchers caution that remission is not the same as cure and say longer follow-up is needed to see whether participants can maintain the weight loss, muscle mass and blood sugar improvements over time. Still, they say the results suggest that early, tightly structured lifestyle treatment could change the outlook for younger adults with type 2 diabetes, especially if future studies confirm that the benefits can be reproduced in routine care.