A rigorous combination of a strict low-calorie diet and supervised exercise helped more than half of younger adults with type 2 diabetes put the disease into remission within six months, according to a new study published in The Lancet Regional Health – Americas.
The research, known as the RESET for Remission trial, found that 54% of participants under age 45 who completed the intensive program achieved remission, compared with just 4% of those receiving standard medical care.
Type 2 diabetes diagnosed before age 45 tends to be more aggressive than cases diagnosed later in life, according to medical literature, often bringing faster loss of blood sugar control, earlier cardiovascular complications and a shorter life expectancy.
Researchers from McGill University in Canada and the University of Leicester in the United Kingdom enrolled 96 adults ages 18 to 45 who were living with obesity and early-onset type 2 diabetes. None were using insulin.
Participants in the intervention group stopped their blood sugar and blood pressure medications under medical supervision and began an 800- to 900-calorie daily diet. For the first two weeks they consumed only meal-replacement products; from weeks three through 12 they were allowed one structured meal of lean protein and vegetables each day in addition to meal replacements, before moving into a 12-week weight-maintenance phase.
The diet was paired with supervised aerobic and resistance training twice a week, plus one additional solo workout each week.
“Our study shows that it is possible to combine a low-calorie diet with supervised exercise in young adults with type 2 diabetes,” said Dr. Kaberi Dasgupta, lead author and a professor of medicine and director of the Division of General Internal Medicine at McGill University. “There has previously been some concern about combining the two as being too much of a burden for people. However, people in our study stayed in our study.”
Only 10% of participants dropped out before the final evaluations, and patients attended a median of 17 of 20 scheduled supervised gym sessions.
Protecting Muscle While Losing Weight
Researchers emphasized resistance training specifically to counter the loss of lean muscle mass that often accompanies rapid weight loss. Experts have warned that crash dieting or appetite-suppressing medications can cause people to shed muscle along with fat, and that if weight returns, it may come back disproportionately as fat, potentially harming muscle health and metabolism over time.
“In our study, we think the diet provoked the weight loss, and exercise helped make sure it was not from muscle,” Dasgupta said. “We were happy and surprised that not only did people lose fat from their organs and liver, our MRI studies indicated their muscle did not decrease at all and their handgrip strength went up.”
Participants lost an average of 18.5 pounds over 24 weeks while significantly improving their treadmill endurance and overall cardiovascular fitness.
To meet the official standard for remission, patients had to maintain an HbA1c level below 6.5% after at least 12 weeks without any glucose-lowering medication. After accounting for baseline health factors, researchers found that patients on the diet-and-exercise program were 21 times more likely to achieve remission than those on routine care.
Limitations and Side Effects
Experts noted the trial was small, involving fewer than 100 people across medical centers in England and Canada over a relatively short six-month period. Dasgupta also acknowledged the study design could not isolate exactly which intervention drove each benefit.
“The main limitation is that we had to compare the diet plus exercise with usual care,” Dasgupta said. “We would have liked to compare diet alone against diet and exercise to perfectly prove the point that the improvements in muscle and fitness were from the exercise.”
About 86% of the intervention group reported mild to moderate side effects, mostly in the early weeks, including headaches, fatigue, dizziness and constipation. Researchers said no severe medical complications occurred.
Health professionals cautioned that diabetes remission is not a permanent cure, and that maintaining an 800-calorie daily intake alongside supervised gym sessions could be difficult for people outside a clinical setting. Study authors said longer-term, real-world trials are still needed to determine whether patients can sustain the weight loss, keep their muscle gains and remain medication-free after resuming normal routines.
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