More than half of young adults with type 2 diabetes went into remission in six months on a strict diet and exercise plan, compared with 4% on usual care

Type 2 diabetes is showing up in more people under 45, and when it starts young it tends to be more aggressive, with complications arriving earlier in life. Researchers at McGill University in Canada and the University of Leicester in the UK tested whether an intensive program could push it into remission. They randomly assigned 96 adults aged 18 to 45 with type 2 diabetes and obesity to usual care or to a strict low-calorie diet with supervised exercise. The main measure was remission at six months.

After 24 weeks, 27 of the 50 people in the diet and exercise program, 54%, were in remission. In the usual-care group, 2 of 46 were, about 4%. After adjusting for other factors, people in the program were 21 times more likely to reach remission.

Remission here had a strict definition: an HbA1c, the standard blood test for average blood sugar over about three months, below 6.5%, with no glucose-lowering medication for at least 12 weeks. It does not mean the disease is cured, and blood sugar can rise again if weight comes back.

People in the program lost an average of 8.4 kilograms, from 100.7 to 92.3 kg, while the usual-care group lost 1.2 kg. After adjustment, the program group lost about 7.5 kg more than the control group, including 6.6 kg more fat.

The idea that diet can reverse type 2 diabetes is not new. In the DiRECT trial, published in The Lancet in 2018, nearly half of UK adults who followed a low-calorie diet in primary care were in remission after a year. A 2020 trial in Qatar found even higher remission rates in younger adults of Middle Eastern origin. The new trial is the first to combine a low-calorie diet with structured exercise in a multi-ethnic group of people diagnosed before 45.

The program was demanding. For the first two weeks, all meals were replaced with formulated shakes and meal replacements. From weeks three to twelve, participants could eat one normal meal a day while staying at 800 to 900 calories, with targets for protein, fruit and vegetables. They exercised under supervision twice a week, with aerobic and resistance training, plus one session on their own. At the start, blood sugar and blood pressure medications were stopped under medical supervision.

The second finding is about muscle. Rapid weight loss usually strips away muscle along with fat, and when weight comes back, it tends to return as more fat. Because the program included resistance training during the hardest phase of dieting, participants kept their muscle and improved its quality and their fitness.

“Our remission rates are at the upper end of those previously reported in the literature for trials of similar duration,” the researchers write. They add that preserving muscle during this kind of weight loss “may have important implications for long-term metabolic health.”

Side effects were common but not severe. Forty-three of the 50 people in the program reported at least one, mostly constipation, headaches, dizziness and tiredness in the early weeks, and these generally passed. No serious adverse events were reported.

For people with type 2 diabetes, this is not something to try alone. Stopping medication and eating 800 calories a day needs medical supervision. But the results are a reason to ask a doctor whether a structured remission program is available, especially for younger patients. Diet shapes metabolism in many ways, from how processed food affects insulin to how diet relates to biological aging.

There are limits to what this shows. The trial was small, lasted only six months and was open-label, meaning participants knew which group they were in, although the main outcome was assessed blind. Most people regain some weight after programs like this, and the researchers say longer studies are needed to see how many stay in remission. The results were presented at the European Association for the Study of Diabetes meeting and published in The Lancet Regional Health – Americas.

Source

Dasgupta K, Bouldé NG, Henson J, et al. “Low energy diet plus supervised exercise vs. usual care alone in people with early-onset type 2 diabetes (RESET for Remission): a randomised, open-label, blinded-endpoint efficacy trial.” The Lancet Regional Health – Americas, 2026.
DOI: 10.1016/j.lana.2026.101664

Also cited

Lean MEJ, Leslie WS, Barnes AC, et al. “Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.” The Lancet, 2018.
DOI: 10.1016/S0140-6736(17)33102-1

Taheri S, Zaghloul H, Chagoury O, et al. “Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial.” The Lancet Diabetes & Endocrinology, 2020.
DOI: 10.1016/S2213-8587(20)30117-0