54% of under-45s with type 2 diabetes reached remission in six months on an intensive diet and exercise plan

In a 96-person trial of adults aged 18 to 45 with early-onset type 2 diabetes and obesity, 54% of those assigned to an intensive diet and exercise plan were in remission at six months. That was 27 of 50 participants, against 2 of 46, about 4%, in the group that stayed on usual care. The result comes from the RESET for Remission trial, presented at the European Association for the Study of Diabetes meeting in Milan.

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An 800 to 900 calorie diet, supervised exercise and a medication stop

The intensive arm followed a low-energy diet of 800 to 900 kilocalories a day, split 30% protein, 50% carbohydrate and 20% fat. For the first two weeks every meal was replaced with nutritional products, and from week 3 to week 12 participants ate one conventional meal a day alongside the products. Supervised aerobic and resistance exercise took place twice a week, with one more session done independently. Weeks 13 to 24 shifted to a weight-maintenance diet with continued independent exercise. Blood sugar and blood pressure medications were stopped at the start under medical supervision, except blood pressure drugs in people with albuminuria.

Remission was defined as an HbA1c below 6.5% (48 mmol/mol) with no glucose-lowering medication for at least 12 weeks, and participants with missing data were counted as not in remission. ScienceDaily’s copy of the EASD release reports that, after adjustment, those on the program were about 21 times more likely to reach remission than those on usual care. A 2021 international consensus statement from the American Diabetes Association, the Endocrine Society, the European Association for the Study of Diabetes and Diabetes UK set the same HbA1c threshold, though it asks for three months off medication.

Weight, fat and muscle outcomes in the intervention group

Body weight in the intensive arm fell from 100.7 kg to 92.3 kg, a loss of 8.4 kg, while the usual-care group went from 103.2 kg to 102.0 kg. Adjusted, that meant 7.5 kg more weight loss, including 6.6 kg more fat loss. Healio’s report from the Milan session adds that fat mass fell 16.5% more than in controls, liver fat 9.1% more, and handgrip strength and cardiorespiratory fitness rose 7.6% and 10.3% more. Fat-free mass and muscle volume changed similarly in both groups, which the investigators count as muscle preservation.

Thomas Yates of the University of Leicester, a lead investigator, said, as reported by Healio, that participants went through significant weight loss while maintaining their muscle mass. He described the visceral and liver fat reductions as comparable to those seen with obesity medications, while noting the intervention produced lower absolute weight loss than those drugs.

Kaberi Dasgupta of McGill University, the other lead investigator, said exercise alone does not tend to produce weight loss, and that pairing it with diet-driven loss is what protected muscle. Attendance held up: median attendance was 10 of 11 dietitian coaching sessions and 17 of 20 supervised exercise sessions. In Dasgupta’s words, “Even though it was a big ask, people liked it.”

Timing shows how the effect moved. Remission stood at 58% at 12 weeks and 54% at 24 weeks, against 4% in usual care at both points. Step counts and moderate-to-vigorous activity were higher in the intensive arm at 12 weeks but no different from usual care by 24 weeks, according to Healio.

Side effects, a small sample and an open-label design

Adverse events were reported by 43 of 50 people in the intensive arm and 6 of 46 on usual care, mainly constipation, headache, dizziness and fatigue early in the diet that generally resolved. No severe adverse events were reported. The trial was open-label, meaning participants and staff knew who received which treatment, though the main outcome was assessed blind, and 86 of the 96 participants (90%) completed the final assessments. Participants came from three centers: the University of Leicester, McGill University and the University of Alberta.

The authors, writing in The Lancet Regional Health – Americas, say the remission rate sits at the upper end of those reported in similar-length trials, and that their findings show the feasibility and efficacy of combining structured aerobic and resistance exercise with the diet. They also say the result needs examination in a longer-term study: the trial ran only 24 weeks, most weight-loss programs are followed by regain, and remission is not a permanent cure. Dasgupta noted the findings may not apply to older patients.

Disclosures and funding are partial. Healio reports that Yates has received funding from Abbott and Biomea Fusion and consults for Regeneron, while Dasgupta reports no relevant financial disclosures. News-Medical’s account of the paper says the authors consider the approach potentially valuable for people seeking or likely to seek pregnancy, but ScienceDaily does not state who paid for the trial. Whether the 27 people in remission at 24 weeks are still there a year later is the question the next study has to answer.

This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.

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