Low-Calorie Diet, Exercise Reversed Type 2 Diabetes Without Meds

A randomized trial of 96 adults with early-onset type 2 diabetes found that 54% assigned to a low-calorie diet and structured exercise met the study’s remission definition at 24 weeks, compared with 4% receiving usual clinical care. The findings, presented at the European Association for the Study of Diabetes annual meeting in Milan and published in The Lancet Regional Health – Americas, suggest an intensive lifestyle program can help some younger adults reach remission without glucose-lowering medication during the measured period.

The intervention began with 12 weeks of meal replacements providing 800 to 900 calories a day, twice-weekly supervised aerobic and resistance exercise, and one independent exercise session each week. A further 12-week maintenance phase used a nutritionally optimized diet, gradually reduced meal replacements, and independent exercise. Participants were randomized in equal proportions to the program or routine clinical care.

Researchers defined remission as HbA1c below 6.5% without glucose-lowering medication for at least 12 weeks. The adjusted odds ratio for remission in the intervention group versus usual care was 21.6, with a 95% confidence interval of 6.2 to 114.5. About 90% of participants completed the final assessment; the study counted people who did not complete it as not having achieved remission.

Participants were 18 to 45 years old, had received a diagnosis within the previous six years, and had baseline HbA1c between 6.5% and 10%, or at least 6.0% if taking medication. Their average age was 38 and average HbA1c was 7.2%. At the start, 74% were taking metformin and 20% an SGLT2 inhibitor; a small minority used a GLP-1 drug. No serious adverse events were reported. Common effects included temporary headaches, constipation, dizziness and fatigue when starting the diet, and mild infections were slightly more frequent in the intervention group.

Remission During Early Adulthood

Early-onset type 2 diabetes can expose people to elevated blood sugar and its potential complications for more years of life. Study presenter Kaberi Dasgupta of McGill University said complications can affect people as they begin careers, relationships or families. The trial’s remission result matters because it tests an intensive, non-surgical approach in a group whose diabetes began before age 45.

The study also reported changes beyond blood sugar. MRI scans showed reductions in several fat measures, including pancreatic, abdominal and thigh fat. The intervention group had greater improvements in handgrip strength, blood pressure, triglycerides, resting heart rate, quality of life, depression symptoms and diabetes distress. More participants met the study’s criteria for hypertension remission than in usual care, 56% versus 27%. These are trial findings; they do not establish how long the changes last or whether they prevent later complications.

How the Program Was Tested

Earlier studies had found that low-energy meal-replacement diets could support diabetes remission, but the source report describes fewer studies combining that approach with structured, supervised exercise. RESET enrolled adults diagnosed before age 45 and compared the combined program with routine clinical care in an open-label trial. The intervention was demanding: participants followed a very-low-calorie meal-replacement phase alongside scheduled exercise before moving to maintenance.

Dasgupta said adherence was a key concern because meal replacements already require substantial commitment and supervised exercise adds another demand. She reported that participants liked the exercise and remained in the study, with nine in ten completing the final assessment. Results were consistent in analyses by sex, ethnicity and country, according to the report, though subgroup consistency does not show that the program will work equally well for every individual.

Study co-investigator Thomas Yates of the University of Leicester said that comparisons with anti-obesity medicines should look beyond total weight loss. The report contrasted the trial’s 16.5-pound weight loss at 24 weeks with 28.4 pounds at 52 weeks in a separate tirzepatide trial, SURPASS-3. Because the studies differed in duration and were not a direct comparison, those figures do not establish that one approach is more effective. Yates pointed to changes in visceral and liver fat as outcomes relevant to the exercise component.

““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

What the Trial Cannot Separate

The trial compared a combined diet-and-exercise program with usual care, so it cannot show how much exercise added to the effect of the low-calorie diet. The study was also small, and its reported outcome was measured at 24 weeks. The available report does not establish whether remission persisted beyond that point, how participants fared over longer follow-up, or whether the program would produce similar results in older adults or people diagnosed longer ago.

The remission measure required participants to remain off glucose-lowering medication for at least 12 weeks while keeping HbA1c below 6.5%. That is the study’s specific definition and time frame; it should not be read as proof that diabetes is permanently cured. The trial report also does not provide enough detail to determine how the results compare with medication-based treatment in a direct, head-to-head test.

Longer Follow-Up and Exercise Effects

Further research will need to test whether remission lasts after the 24-week assessment and clarify the additional effect of structured exercise. Yates called for research to confirm that contribution. Longer follow-up could also show whether reported improvements in blood pressure, fat measures, strength and quality of life persist, and how often participants need ongoing dietary or exercise support.

For now, the reported findings concern a specific, intensive program and a selected group of younger adults. The study does not establish that participants should stop medication on their own; its remission outcome was assessed under a defined trial protocol. The published report provides the current results, while the durability and broader applicability of the approach remain open questions.

Key Questions

What did the trial find?

At 24 weeks, 54% of participants in the diet-and-exercise group met the study’s remission definition, compared with 4% receiving usual care.

How did researchers define remission?

Participants had to have HbA1c below 6.5% without glucose-lowering medication for at least 12 weeks.

What did the intervention involve?

It included 12 weeks of 800-to-900-calorie daily meal replacements and scheduled supervised and independent exercise, followed by 12 weeks of dietary and exercise maintenance.

Does the result show that exercise caused the remission?

No. The trial compared the combined program with usual care, so it could not isolate the added effect of exercise from the diet.

Is the remission result known to last?

The reported outcome was measured at 24 weeks. The source report does not establish whether remission continued beyond that assessment.

Source: rss