What the trial found
A structured program combining a low-calorie diet with regular exercise put type 2 diabetes into remission for more than half of younger adults who followed it, according to a randomized clinical trial. 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.
After 24 weeks, 27 of the 50 participants in the intensive group, or 54%, had achieved remission. In the standard-care group, two of 46 people, roughly 4%, did so. After statistical adjustment, the researchers calculated that those in the intensive program were 21 times more likely to reach remission than those receiving usual care.
Weight loss also differed sharply. Among 47 intervention participants with available data, average weight fell from 100.7 kg to 92.3 kg, a drop of 8.4 kg. The 43 control participants with data lost an average of 1.2 kg. After adjustment, the intervention group lost 7.5 kg more, including 6.6 kg more fat.
How the study worked
The research was led by Professor Kaberi Dasgupta of McGill University in Montreal and Professor Thomas Yates of the University of Leicester in the UK, along with colleagues. It took place at three centers affiliated with Leicester, McGill and the University of Alberta in Edmonton.
Between September 24, 2021, and June 6, 2025, the team enrolled 96 adults aged 18 to 45 who had early-onset type 2 diabetes and obesity but were not using insulin. Forty were in the UK and 56 in Canada. The mean age was 38 years. Of those enrolled, 86 completed the final assessments. The trial was open-label, though the main outcome was assessed in a blinded way.
One group kept receiving usual care. The other began with 800 to 900 calories a day, supervised aerobic and resistance exercise twice weekly and one independent session each week for the first 12 weeks. Participants then moved to a diet designed to maintain weight loss while continuing to exercise on their own through week 24.
Diet details and the definition of remission
For the first two weeks, all meals were replaced with specially formulated nutritional products. From weeks three to 12, calories stayed the same, but participants could eat one conventional meal a day, with targets for protein, fruit and vegetables. Participants stopped blood sugar and blood pressure medications at the start, under medical supervision.
Remission required an HbA1c below 6.5% (48 mmol/mol) and no glucose-lowering medication for at least 12 weeks. HbA1c is a blood test reflecting average blood sugar over about three months. Researchers counted missing remission data as no remission, a conservative approach. Remission does not necessarily mean the disease is permanently cured.
Side effects and what the authors say
No severe adverse events were reported. Still, at least one adverse event occurred in 43 of the 50 intervention participants, compared with six of 46 in standard care. Most arose early in the restrictive diet and included constipation, headaches, dizziness and fatigue. These effects generally resolved.
The authors wrote that the findings "demonstrate the feasibility and efficacy of combining structured aerobic and resistance exercise with a low energy diet in early-onset type 2 diabetes." They added that their remission rates are "at the upper end of those previously reported in the literature for trials of similar duration." They also said it was the first demonstration of such effects in a multi-ethnic population with early-onset type 2 diabetes using this combined approach.
