A carefully structured combination of diet and exercise can be an effective way to put type 2 diabetes into remission in young adults. In a new clinical trial, more than half of participants who completed an intensive lifestyle program achieved remission in just six months, compared to just 4% of those receiving standard care.
The results, presented at the annual meeting of the European Association for the Study of Diabetes (EASD) and published in The Lancet Regional Health Americassuggest that a low-calorie diet combined with regular physical activity could significantly modify the course of early-onset type 2 diabetes (EOT2D) (in those under 45 years of age).
The research was led by Professor Kaberi Dasgupta, director of the division of general internal medicine at McGill University in Montreal, Canada, Professor Thomas Yates of the University of Leicester in the United Kingdom, and their colleagues.
Why early-onset type 2 diabetes is particularly dangerous
Type 2 diabetes diagnosed at a younger age can be particularly aggressive. People with early-onset type 2 diabetes (EOT2D) often experience a more rapid decline in blood sugar control, develop complications earlier in life, and have a shorter life expectancy than those diagnosed at older ages.
Previous research has shown that very low-calorie diets (VLEs) can lower blood sugar enough that some people achieve remission without diabetes medications (T2D remission). Remission means that blood sugar has fallen below the threshold used to diagnose diabetes and remains there without glucose-lowering medications. However, this does not necessarily mean that the disease is permanently cured.
The researchers wanted to know if adding structured exercises could make this approach even more effective. In addition to helping regulate blood sugar, physical activity may improve fitness, protect muscles during weight loss, strengthen heart function and reduce insulin resistance.
To investigate, the team tested whether combining a low-calorie diet with supervised exercise could achieve remission after 24 weeks, compared to standard medical care.
An intensive diet and exercise program
The randomized clinical trial took place at three research centers in England and Canada (affiliated with the University of Leicester, UK, McGill University (Montreal), and the University of Alberta, Edmonton). It recruited adults aged 18 to 45 who had early-onset type 2 diabetes and obesity but did not use insulin.
The trial was open-label, meaning participants and researchers knew which treatment each person was receiving, although the assessment of the primary outcome was blinded.
One group continued to receive usual care. The other followed an intensive program combining a daily intake of 800 to 900 calories with supervised aerobic and resistance exercises twice per week, as well as an independent exercise session each week (weeks 1 to 12). Participants then transitioned to a diet designed to maintain their weight loss while continuing to exercise independently (weeks 13–24).
The researchers measured how many participants achieved diabetes remission after 24 weeks. To be eligible, participants had to have an HbA1c level below 6.5%, equivalent to 48 mmol/mol, and must have not taken any hypoglycemic medication for at least 12 weeks. HbA1c is a blood test that reflects average blood sugar levels over approximately three months.
The analysis included everyone assigned to either group. When remission data was missing, researchers conservatively counted these participants as not having achieved remission. They also looked at changes in cardiovascular fitness, body composition and heart structure.
What participants ate during the study
At the start of the intensive program, participants stopped medications used to lower blood sugar and blood pressure (in the absence of albuminuria), under study medical supervision. Albuminuria refers to the presence of a protein called albumin in the urine and may indicate kidney damage.
Their restricted diet provided them with 800 to 900 calories per day (30% protein, 50% carbohydrates, 20% fat). Participants were encouraged to drink at least two liters of calorie-free fluids each day and were given access to a fiber-based laxative when needed.
During the first two weeks, all meals were replaced with specially formulated nutritional products (Optifast). From the third to the twelfth week, participants maintained the same calorie limit but gained flexibility in their food choices (Optifast in the United Kingdom and ProteinDiet in Canada).
This second phase allowed one conventional meal per day, with daily intake goals including proteins, fruits and vegetables (60 to 90 g of protein from all sources, one serving of fruit, two servings of non-starchy vegetables).
After the first 12 weeks, participants shifted toward maintaining their weight loss rather than rapidly and continuously reducing their weight.
More than half achieved remission from type 2 diabetes
Between September 24, 2021 and June 6, 2025, researchers recruited and randomly assigned 96 participants (40 to the United Kingdom, 56 to Canada). The group included 50 people assigned to the intensive intervention and 46 people receiving standard care (24 women, 26 men in the intervention group; 21 women, 25 men in the control group; mean age 38 years, BMI 35.2 kg/m2).
Of those registered, 86 (90%) completed the final assessments.
The results revealed a striking difference between the groups. After 24 weeks, 27 of the 50 participants following the diet and exercise program had achieved remission, representing 54% of the intervention group. In comparison, only two of 46 participants receiving standard care achieved remission, or about 4%.
After accounting for relevant statistical factors, the researchers calculated that participants in the intensive lifestyle program were 21 times more likely to achieve remission than those receiving usual care.
Weight loss was also significantly greater among participants following the combined program.
Among the 47 intervention participants with available weight data, average body weight decreased from 100.7 kg to 92.3 kg, a reduction of 8.4 kg over 24 weeks. The 43 control participants with available weight data started with an average of 103.2 kg and lost only 1.2 kg, reaching 102.0 kg.
After statistical adjustment, the intervention group lost on average 7.5 kg more than the control group. Importantly, this included an additional 6.6kg of fat loss, indicating that much of the difference came from a reduction in body fat.
Promising results with manageable side effects
No serious adverse events were reported during the trial. However, side effects were more common in participants following an intensive diet.
At least one adverse event occurred in 43 of 50 intervention participants, compared to six of 46 participants receiving standard care. Most problems appeared during the early stages of the restrictive diet and included symptoms such as constipation, headache, dizziness, and fatigue (eg, constipation, headache, dizziness, fatigue). These effects have generally disappeared.
The researchers believe the results demonstrate that a combined diet and exercise intervention can produce significant improvements beyond blood sugar control alone.
The authors state: “Our results demonstrate the feasibility and effectiveness of combining structured aerobic and resistance exercise with a low-energy diet in early-onset type 2 diabetes, confirming its potential to provide substantial and holistic health and well-being benefits alongside diabetes remission.
“Our remission rates are at the high end of those previously reported in the literature for trials of similar duration, reinforcing the potential for structured lifestyle interventions to support clinically meaningful remission, while demonstrating for the first time that such effects can be achieved in a multi-ethnic population with early-onset type 2 diabetes through a combined low-energy diet and structured exercise intervention.”
Why it is important to preserve muscle during weight loss
A particularly important aspect of the study was the emphasis on protecting muscle mass during rapid weight loss.
Researchers explain that most people who follow a weight loss program end up regaining some or all of the weight they lost. This is particularly relevant when using very low calorie diets to achieve diabetes remission.
Losing weight through calorie restriction alone generally reduces both fat mass and fat-free mass, which includes muscle. Some data suggests that when weight returns, the body may regain proportionally more fat than lean tissue.
Over time, repeated weight loss and gain could therefore contribute to a progressive reduction in muscle mass and increase the risk of sarcopenia, a condition characterized by a reduction in muscle mass and strength.
To address this problem, researchers incorporated resistance training into the most intensive phase of weight loss. Their results suggest that it is possible to achieve substantial fat loss while preserving muscle, which could make this approach more beneficial for long-term metabolic health.
They state: “Our RESET for Remission study targeted muscle during the intensive phase of weight loss through resistance training, and our results indicate that fat-free mass and muscle preservation are achievable with rapid weight loss. Muscle preservation during remission-oriented weight loss may have important implications for long-term metabolic health, physical function, and disease trajectory. This requires examination in a longer-term study. »
A potential new approach to treating type 2 diabetes
These findings could be particularly important as type 2 diabetes becomes increasingly common among young adults around the world.
People who develop the disease earlier in life are exposed to higher blood sugar levels for more years, increasing their risk of cardiovascular disease and other complications during their lifetime. Finding effective ways to achieve early remission could therefore have substantial health benefits.
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