Type 2 Diabetes Breakthrough: Diet and Exercise Put 54% of Young Adults Into Remission in Just Six Months

More than half of younger adults with type 2 diabetes who followed an intensive, medically supervised program of low-calorie eating and structured exercise saw their disease go into remission within six months, according to a new clinical trial.

The study found that 54% of participants under age 45 who completed the program reached remission, compared with about 4% of those who received standard medical care. The results were presented at the annual meeting of the European Association for the Study of Diabetes and published in The Lancet Regional Health – Americas.

The trial, known as RESET for Remission, was led by Kaberi Dasgupta, director of the Division of General Internal Medicine at McGill University in Montreal, and Thomas Yates of the University of Leicester in England.

A growing threat to younger adults

The research focused on early-onset type 2 diabetes, defined as a diagnosis before age 45, a form of the disease that is becoming more common worldwide and tends to be more aggressive.

People diagnosed younger often see their blood sugar control deteriorate faster, develop complications earlier and face shorter life expectancy than those diagnosed later in life. Because they live with elevated blood sugar for more years, they also carry a higher lifetime risk of heart disease and other complications.

Earlier studies have shown that very low-calorie diets can lower blood sugar enough for some patients to stop taking diabetes medication. Researchers wanted to know whether adding supervised exercise would boost those results while protecting muscle and heart health.

How the trial worked

The randomized trial enrolled 96 adults ages 18 to 45 at three research centers in England and Canada, affiliated with the University of Leicester, McGill University and the University of Alberta in Edmonton. All participants had early-onset type 2 diabetes and obesity and were not using insulin.

Their average age was 38, and their average body mass index was 35.2. Fifty were assigned to the intensive program and 46 continued with usual care. Enrollment ran from September 2021 to June 2025, and 90% of participants completed the final assessments.

The trial was open-label, meaning participants and researchers knew who was receiving which treatment, though the main outcome was assessed by evaluators who were not told group assignments.

Participants in the intensive group stopped taking medications for blood sugar and, in most cases, blood pressure under the supervision of study doctors. They then followed a diet of 800 to 900 calories a day for 12 weeks.

For the first two weeks, all meals were replaced with specially formulated nutrition products. From weeks three through 12, participants could eat one regular meal a day while staying within the calorie limit, with daily targets for protein, fruit and non-starchy vegetables.

During that same period, they completed supervised aerobic and resistance training twice a week, plus one exercise session on their own. In the second 12 weeks, they shifted to a diet designed to maintain their weight loss and continued exercising independently.

To count as being in remission, participants needed an HbA1c reading below 6.5%, the threshold used to diagnose diabetes, and had to have gone at least 12 weeks without any glucose-lowering medication. HbA1c is a blood test that reflects average blood sugar over roughly three months.

Striking results

After 24 weeks, 27 of the 50 participants in the intensive program had reached remission. Only two of the 46 participants in the usual-care group did.

After adjusting for other factors, the researchers calculated that people in the lifestyle program were 21 times more likely to achieve remission.

Weight loss was also far greater. Participants in the intensive group dropped from an average of 100.7 kilograms to 92.3 kilograms, a loss of about 8.4 kilograms, or roughly 18.5 pounds. Those receiving usual care lost an average of just 1.2 kilograms.

After adjustment, the intervention group lost about 7.5 kilograms more than the control group, including 6.6 kilograms more fat, indicating most of the difference came from body fat rather than muscle.

The researchers said their remission rates were among the highest reported in trials of similar length and the first to show such results in a multiethnic group with early-onset diabetes using combined diet and exercise.

Protecting muscle during weight loss

A key goal of the study was preserving muscle during rapid weight loss, a concern with very low-calorie diets.

Weight loss through calorie cutting alone typically reduces both fat and lean tissue, including muscle. Because many people regain weight after dieting, and some evidence suggests the body may regain proportionally more fat than muscle, repeated cycles could gradually erode muscle mass and raise the risk of sarcopenia, a condition marked by declining muscle mass and strength.

By adding resistance training during the most intensive phase, the researchers found participants were able to lose substantial fat while maintaining muscle. The authors said their findings indicate that "fat-free mass and muscle preservation is achievable with rapid weight loss."

They also reported improvements in muscle quality, physical performance, heart health and participants' sense of well-being.

Side effects common but mild

No serious adverse events were reported. However, side effects were far more common in the intensive group, with 43 of 50 participants experiencing at least one, compared with six of 46 in the usual-care group.

Most occurred early in the restrictive diet and included constipation, headaches, dizziness and fatigue. The symptoms generally went away.

Remission is not a cure

Experts caution that remission does not mean diabetes has been permanently cured. It means blood sugar has fallen below the diagnostic threshold and stays there without medication, but levels can rise again, particularly if weight returns.

The researchers also stressed that the program was closely supervised by medical staff, including the decision to stop medications. Very low-calorie diets can cause blood sugar and blood pressure to change quickly, and people with diabetes should not attempt such a plan or stop medications without guidance from their doctor.

The study was also relatively small and lasted only six months. The authors said longer studies in real-world settings are needed to see whether participants can maintain weight loss, muscle mass and remission after leaving a tightly monitored clinical trial.

What comes next

The findings build on earlier research, including the landmark DiRECT trial in the United Kingdom, which showed that a structured weight-management program could put type 2 diabetes into remission for many patients in primary care.

The new trial's authors said their results point to an opportunity to rethink how early-onset type 2 diabetes is treated and to expand access to combined diet and exercise programs. They added that the approach may be particularly valuable for people who are planning a pregnancy or could become pregnant.

As rates of type 2 diabetes continue to climb among younger adults, researchers say finding ways to achieve remission early could spare patients decades of complications and reduce the long-term burden on health care systems.