Study shows low energy diet combined with structured exercise reverses early onset type 2 diabetes in half of participants

New research published in The Lancet Regional Health Americas shows that around half of people diagnosed with early-onset type 2 diabetes before the age of 45 can achieve remission through a low-energy diet combined with a structured exercise programme. 

The study, led by the University of Leicester's Professor of Physical Activity and Health, Tom Yates, and Professor Kaberi Dasgupta, Director of the Division of General Internal Medicine at McGill University, Canada, was presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy.

Early-onset type 2 diabetes (EOT2D) is a distinct and growing clinical phenotype with rapid deterioration in blood sugar control, early onset of complications, and lower life expectancy than later onset T2D. 

Low energy diets (LEDs) can reduce glucose levels below T2D diagnostic thresholds without medication (T2D remission). Adding structured exercise may provide synergistic benefits including greater fitness, muscle mass preservation, enhanced cardiac function, and lower insulin resistance. 

The researchers evaluated the efficacy of combining a LED with supervised exercise on remission at 24 weeks in EOT2D, a condition meriting a potent intervention to arrest its rapid evolution, comparing it to usual care.

Across three centres in England and Canada (affiliated with the University of Leicester, McGill University (Montreal), and the University of Alberta, the team conducted a randomised, open-label, blinded endpoint efficacy trial among adults 18 to 45 years of age with EOT2D and obesity, not on insulin therapy. 

The study compared two groups of people with early-onset type 2 diabetes. One group received standard care, while the other followed a low-calorie diet of 800-900 calories a day alongside a structured exercise programme for 12 weeks, followed by a healthy weight-maintenance plan and continued exercise for another 12 weeks.

Participants in the diet and exercise group stopped taking their diabetes and blood pressure medication where appropriate and followed a meal-replacement programme for the first two weeks. For the next 10 weeks, they continued the low-calorie diet but were allowed one regular meal a day, including protein, fruit and vegetables.

Researchers assessed whether participants were in remission after 24 weeks, meaning their blood sugar levels were below the diabetes threshold and they had not needed diabetes medication for at least three months. They also looked at changes in fitness, body fat and heart health.

The trial involved 96 adults in the UK and Canada, with an average age of 38 and an average starting weight of just over 100kg. Nine out of 10 participants completed the study.

After 24 weeks, 54% of people in the diet and exercise group were in remission, compared with just 4% in the standard-care group. Overall, those in the intervention group were around 21 times more likely to achieve remission.

Those on the diet and exercise programme lost an average of 7.5kg more weight than those in the standard-care group. Importantly the vast majority of this weight loss came from a loss of fat-mass. Muscle mass, as assessed by advanced magnetic resonance imaging (MRI) was preserved with diet and exercise despite the overall weight loss. In addition, the amount of fat infiltration in the muscle substantialy reduced, whilst strength and fitness increased as a result of the intervention. The structure of the heart was also positively changed. 

Remission was achieved without severe adverse events. Most intervention group participants experienced at least one adverse event (43/50 vs. 6/46), mainly early low energy diet effects (e.g, constipation, headache, dizziness, fatigue) that resolved.

The authors say: “Our findings demonstrate the feasibility and efficacy of combining structured aerobic and resistance exercise with a low energy diet in early onset type 2 diabetes, supporting its potential to deliver substantial and holistic health and well-being benefits alongside diabetes remission.

“Our remission rates are at the upper end of those previously reported in the literature for trials of similar duration, reinforcing the potential of structured lifestyle interventions to support clinically meaningful remission, while demonstrating for the first time that such effects can be achieved in a multi-ethnic population with early onset type 2 diabetes through a combined low energy diet and structured exercise intervention.”

“Our RESET for Remission study targeted muscle during the intensive weight loss phase through resistance training, and our findings indicate muscle mass preservation is achievable with rapid weight loss. Preserving muscle during remission-oriented weight loss may have important implications for long-term metabolic health, risk of disability and frailty, and longer-term disease trajectory. This requires examination in a longer-term study.”

They conclude: “By focusing specifically on early onset type 2 diabetes, our trial addresses a growing clinical population, characterised by elevated cardiovascular disease risk, greater cumulative complication burden, and poor long-term outcome. In summary, RESET for Remission demonstrated that in early onset type 2 diabetes, combining structured aerobic and resistance exercise with a low-calorie diet produces high remission rates, induces fat loss while preserving muscle mass, improves muscle quality and function, enhances cardiovascular health, and leads to meaningful improvements in patient-reported outcomes. 

“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. Our approach may be particularly valuable in those seeking or with potential for pregnancy. It warrants further evaluation in longer term studies in real-world settings."