Diet and exercise put type 2 diabetes into remission for 54% of young adults in trial

Within six months, more than half of young adults with type 2 diabetes achieved remission by adhering to a structured regimen of meal replacements and supervised exercise — a rate researchers describe as among the highest ever documented for this age group, holding steady across sexes, ethnicities, and two countries.

Published in The Lancet Regional Health – Americas and presented at the European Association for the Study of Diabetes annual meeting in Milan, the RESET for Remission trial enrolled 96 adults between the ages of 18 and 45 — average age 38, all living with obesity and early-onset type 2 diabetes — and randomly placed them into either an intensive lifestyle intervention or standard clinical care. After 24 weeks, 27 of the 50 people in the intervention group had achieved remission (54%), against just 2 of 46 in the usual-care group (4%). After adjusting for relevant statistical factors, the intervention group was 21 times more likely to reach remission.

Remission was defined strictly: an HbA1c blood-sugar reading below 6.5% with no glucose-lowering medication for at least 12 weeks. It does not mean the disease has been permanently cured.

The program worked in two phases. During the opening 12 weeks, participants limited their intake to 800 to 900 calories daily — drawn mainly from meal-replacement shakes and bars — and completed two supervised aerobic and resistance exercise sessions each week alongside one independent session. Blood-sugar and blood-pressure medications were discontinued at the outset under medical supervision. From weeks 13 to 24, participants shifted to a food-based diet designed to maintain their weight loss and continued exercising independently.

It's already quite a lot to ask someone to adhere to a meal-replacement diet. Adding supervised exercise makes it even more challenging. Will they be able to do it? The nice thing is, if they can do it, they stand to have the benefits of the low-energy diet — the weight loss and the remission — and perhaps also the benefits of exercise.— Kaberi Dasgupta, MD, MSc, McGill University

Most could do it. Ninety percent of participants completed their final assessments — a retention rate researchers described as notable given the demands of the program. Non-completers were conservatively counted as not having achieved remission, making the 54% figure, if anything, an underestimate of the program's effect among those who fully engaged.

The intervention produced benefits well beyond blood-sugar control. Participants in the intensive program lost on average about 7.5 kg more than the usual-care group, according to the McGill University Health Centre. Crucially, that weight came off as fat rather than muscle — a distinction the researchers treated as a central goal of the design. Rapid dieting alone often strips away lean mass, and weight regained after such losses tends to return as fat, raising long-term risks. By pairing the diet with resistance exercise, the trial aimed to break that pattern.

We know that these therapies produce substantial weight loss, but 25% to 45% of weight loss with therapies comes from lean mass. It's really important when we're talking about exercise that we look beyond total weight, because that is what's going to be driving the metabolic benefits.— Thomas Yates, PhD, University of Leicester

According to MedPage Today, whole-body MRI scans revealed improvements in pancreatic fat fraction, abdominal and thigh subcutaneous fat, abdominal and thigh intermuscular fat, and thigh intramuscular fat. When set against tirzepatide (Mounjaro) figures from the SURPASS-3 trial, the RESET intervention yielded a smaller total weight reduction — 16.5 lb at 24 weeks compared with 28.4 lb at 52 weeks — yet achieved greater decreases in visceral fat and liver fat fraction.

Gains were also recorded in handgrip strength, cardiovascular fitness, blood pressure, resting heart rate, triglyceride levels, and cardiac geometry. More than half of those in the intervention group achieved hypertension remission (56%), compared with 27% in the usual-care group. According to the McGill University Health Centre, participants additionally experienced reduced symptoms of depressed mood, lower diabetes-related distress, and an improved quality of life.

Early side effects — constipation, headaches, dizziness, and fatigue — were common at the start of the diet phase but passed. There were no serious adverse events. The intervention arm did show a slightly higher rate of mild infections.

The focus on adults under 45 reflects a specific and growing clinical problem. Early-onset type 2 diabetes tends to progress faster than the same disease diagnosed later in life, bringing complications sooner and shortening life expectancy. It also strikes at the stage of life when people are building careers, starting families, or considering pregnancy — a point the researchers highlighted because weight-loss medications are not recommended during pregnancy and their long-term effects over decades of use remain unknown.

Those complications can hit when they're about to start a family, start a relationship, start a job — it's very inconvenient, and it causes a lot of suffering.— Kaberi Dasgupta, MD, MSc, McGill University

The trial was the first to test a low-calorie meal-replacement diet paired with structured supervised exercise in a multi-ethnic group of young adults with early-onset type 2 diabetes, according to the McGill University Health Centre. Research sites were affiliated with McGill University in Montreal, the University of Alberta in Edmonton, and the University of Leicester in the UK; funding came from the UK Medical Research Council and the Canadian Institutes of Health Research, with additional support from the John R. McConnell Foundation.

One significant limitation: because the trial had only two arms — intervention versus usual care — it cannot confirm that exercise specifically was responsible for preserving muscle and improving fitness, even though the known effects of exercise point in that direction. According to the researchers, the logical next step is a larger, longer study that compares diet alone against diet combined with exercise in real-world settings.

As the prevalence of early onset type 2 diabetes rises globally, our findings highlight an opportunity to re-evaluate treatment paradigms and support scalable implementation of integrated dietary and exercise interventions for remission.— RESET for Remission researchers

Why it matters — Early-onset type 2 diabetes is rising globally and hits hardest during working and family-building years, yet non-surgical remission options have been limited — this trial offers the strongest evidence yet that a structured diet-and-exercise program can reverse the disease in more than half of younger patients, while also protecting muscle and improving heart health.

Reported by sciencedaily.com, medpagetoday.com, muhc.ca