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A randomized trial found that 54% of participants with early-onset type 2 diabetes met the study’s remission definition after a low-calorie meal-replacement diet and structured exercise, compared with 4% receiving usual care. Remission meant HbA1c below 6.5% without glucose-lowering medication for at least 12 weeks; the findings do not establish a permanent cure or show that participants can stop treatment without medical supervision.
A structured low-calorie diet and exercise program put type 2 diabetes into remission at 24 weeks for 54% of young adults in a randomized trial, compared with 4% receiving usual clinical care, according to results presented at the European Association for the Study of Diabetes meeting and published in Lancet Regional Health Americas. The study involved 96 adults with early-onset diabetes; remission was defined as HbA1c below 6.5% without glucose-lowering medication for at least 12 weeks.
The open-label RESET for Remission trial randomly assigned participants in equal numbers to the intervention or routine clinical care. Participants were ages 18 to 45, had been diagnosed within the previous six years, and had a mean starting HbA1c of 7.2%. At the start of the study, 74% were taking metformin, 20% an SGLT2 inhibitor, and a small minority a GLP-1 drug.
For the first 12 weeks, the intervention used a daily 800-to-900-calorie meal-replacement diet, supervised aerobic and resistance exercise twice a week, and independent exercise once a week. A further 12-week maintenance phase used a nutritionally optimized diet, a gradual reduction in meal replacements and independent exercise. The researchers reported an adjusted odds ratio for remission of 21.6 versus usual care, with a 95% confidence interval of 6.2 to 114.5.
Ninety percent of participants completed the final assessment. People who did not complete it were counted as not having achieved remission, investigator Kaberi Dasgupta of McGill University said. The intervention group also showed improvements in several reported measures, including blood pressure, triglycerides, quality of life, diabetes distress and aspects of body fat measured by whole-body MRI. No serious adverse events were reported; temporary headaches, constipation, dizziness and fatigue were among the common diet-initiation symptoms, and mild infections were somewhat more frequent in the intervention group.
Remission Without Medication at 24 Weeks
The results suggest that, for some younger adults with relatively recent type 2 diabetes, a combined diet and exercise program can produce short-term remission while participants are off glucose-lowering medication. Early-onset diabetes is a concern because people may face the disease and its complications during working, family-building and other early-adult years. The trial adds evidence about a structured approach for this group, rather than relying on diet alone.
The findings are not evidence that diabetes has been permanently cured. The reported outcome was measured at 24 weeks and required a defined period without medication; longer follow-up is needed to learn how durable remission is and how many people maintain it. The program also required substantial dietary and exercise commitments, so its feasibility and results may differ outside a trial setting. Medication changes should be overseen by a clinician.
Researchers also reported changes in body composition and physical and mental health measures. Co-investigator Thomas Yates of the University of Leicester said the intervention’s effects should be considered beyond total weight loss, pointing to changes in fat distribution and exercise-related measures. Those findings offer possible avenues for further study, but the trial does not establish which part of the program caused each improvement.
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Why Researchers Tested Exercise Alongside Diet
Low-energy meal-replacement diets have been studied as a nonsurgical means of achieving diabetes remission. The trial authors said fewer studies had examined them alongside a structured, supervised exercise program, particularly in young adults with early-onset type 2 diabetes. RESET tested the combined program against routine care, rather than comparing diet and exercise separately, so it cannot isolate the added effect of exercise.
Dasgupta said adherence was a concern because following a meal-replacement diet is demanding and adding supervised exercise makes the commitment greater. She reported that participants remained in the study and completed assessments at a high rate. Remission rates were reported as consistent across subgroup analyses by sex, ethnicity and study country, although the trial included only 96 people and subgroup results do not establish that the program will work equally well for every population.
Yates compared the trial’s weight findings with outcomes reported for tirzepatide in a separate study, SURPASS-3. The RESET intervention group lost 16.5 pounds at 24 weeks, while the cited tirzepatide result was 28.4 pounds at 52 weeks. These are results from different studies and different follow-up periods, not a direct head-to-head comparison. Yates said weight alone may not capture changes relevant to metabolic health, but further research is needed to test the intervention’s distinct contributions.
““It’s already quite a lot to ask someone to adhere to a meal-replacement diet. Adding supervised exercise makes it even more challenging.””
— Kaberi Dasgupta, MD, MSc, McGill University
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Durability and Exercise’s Separate Effect
The reported remission outcome covers 24 weeks; the source material does not provide longer-term results showing whether remission persisted after the study period. It is also not clear how often participants might later need medication again or what maintenance support would be required in routine care.
Because the trial had two arms—combined diet and exercise versus usual care—it cannot show whether exercise added benefit beyond the diet, or identify the separate effect of each program component. The small sample also limits what can be concluded from subgroup comparisons. Although no serious adverse events were reported, the study does not establish whether the demanding regimen is suitable for every person with type 2 diabetes.
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Longer Follow-Up and Component Trials
Researchers say further studies are needed to confirm the additional contribution of exercise and assess how durable remission is beyond the reported 24-week results. Trials that compare diet alone, exercise alone and the combined program could help distinguish their effects. Follow-up can also clarify which participants maintain remission and what support is needed over time.
For now, the findings describe a structured research intervention, not a recommendation for people to stop medication or begin a very-low-calorie diet on their own. Anyone considering major diet changes or changes to diabetes treatment should discuss them with a qualified health professional, who can assess individual needs and monitor care.
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Key Questions
What did the trial mean by diabetes remission?
It defined remission as HbA1c below 6.5% without glucose-lowering medication for at least 12 weeks. This study outcome does not mean diabetes was permanently cured.
How many participants achieved remission?
At 24 weeks, 54% of the intervention group met the remission definition, compared with 4% receiving usual care. The trial randomized 96 participants in total.
What did the intervention involve?
It included an 800-to-900-calorie daily meal-replacement diet and supervised aerobic and resistance exercise twice weekly for 12 weeks, followed by a 12-week maintenance phase with a nutritionally optimized diet and independent exercise.
Does this mean people with diabetes should stop their medication?
No. Medication status was part of a defined trial outcome, and the results are not advice to stop treatment. Any medication change or substantial diet change should be discussed with a clinician.
Did the study show that exercise alone caused the remission?
No. The researchers tested diet and exercise together against usual care. They said further research is needed to confirm the added benefit of exercise separately.
Source: rss
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