A six-month intensive lifestyle program combining a low-energy diet with structured aerobic and resistance exercise put early-onset type 2 diabetes into remission in 54% of participants, compared with 4% receiving usual care, according to the randomized RESET for Remission trial published in The Lancet Regional Health – Americas.
Early-onset type 2 diabetes carries a high lifetime burden
Type 2 diabetes diagnosed in young adulthood is increasingly recognized as a particularly aggressive form of the disease. Compared with later-onset type 2 diabetes, early-onset disease is associated with longer lifetime exposure to high blood sugar, faster progression of complications, and a higher cumulative risk of cardiovascular, kidney, eye and nerve disease.
The RESET for Remission trial was designed around that problem. Rather than asking whether lifestyle changes could merely improve glucose control, researchers tested whether a relatively intensive intervention could push blood sugar below the diabetes threshold without glucose-lowering medication.
The study enrolled adults ages 18 to 45 with obesity and type 2 diabetes that had developed relatively early in life. Participants were not using insulin therapy. The mean age was 38 years and the average body mass index was 35.2 kg/m².
The intervention combined a very-low-energy diet with structured exercise
Ninety-six participants were randomized across three centers in Canada and England. Fifty were assigned to the intervention and 46 to usual care.
During the first 12 weeks, the intervention group followed a low-energy diet providing about 800 to 900 kcal per day. The diet provided roughly 30% of energy from protein, 50% from carbohydrate and 20% from fat.
The first two weeks used total meal replacement. From weeks 3 through 12, participants remained within the same calorie range but were allowed more food variety, including one food-based meal per day with protein, fruit and non-starchy vegetables.
Participants also completed supervised aerobic and resistance exercise twice a week plus one independent exercise session each week. During weeks 13 through 24, they moved to a weight-maintenance diet and continued exercise independently.
Glucose-lowering medications were stopped at the start of the dietary intervention, with medical monitoring. Blood-pressure medication was also stopped in participants without albuminuria, according to the trial protocol.
More than half of the intervention group reached remission at 24 weeks
The primary endpoint was diabetes remission at 24 weeks. The study defined remission as an HbA1c below 6.5% and no glucose-lowering medication for at least 12 weeks.
By week 24, 27 of 50 people in the intervention group met that definition, compared with 2 of 46 people receiving usual care. That corresponds to remission rates of 54% and 4%, respectively.
After statistical adjustment, the intervention group had substantially higher odds of remission, with an adjusted odds ratio of 21.6. The confidence interval was wide, from 6.2 to 114.5, reflecting the relatively small size of the trial.
The result is clinically striking, but remission does not mean that type 2 diabetes has been permanently cured. Blood sugar can rise again if weight is regained or metabolic function deteriorates over time.
Weight loss was large and came mainly from fat mass
Weight loss differed markedly between the two groups.
Among participants with follow-up measurements, the intervention group lost an average of 8.4 kg over 24 weeks, compared with 1.2 kg in the usual-care group. Statistical adjustment indicated an average between-group difference of about 7.5 kg.
Most of that difference came from fat loss. The intervention group lost about 6.6 kg more fat mass than usual care, while the study reported preservation of fat-free mass and muscle volume.
That is an important part of the trial design. Weight-loss interventions can reduce both fat and lean tissue, so the researchers deliberately combined energy restriction with aerobic and resistance exercise in an effort to preserve muscle and improve fitness.
Exercise may add benefits beyond weight loss alone
Previous remission studies, including the DiRECT trial, have shown that substantial weight loss through low-energy diets can put type 2 diabetes into remission in a meaningful proportion of participants. The RESET trial tested whether adding structured exercise could improve body composition, fitness and cardiovascular health while still achieving remission.
The researchers reported improvements in cardiorespiratory fitness, muscle quality and function, and other cardiovascular measures in the intervention group. Those findings support the idea that the program did more than lower body weight.
However, this trial was not designed to isolate the independent effect of exercise. Because the intervention group received both the low-energy diet and the structured exercise program, the study cannot tell us how much of the remission rate came from calorie restriction, how much came from exercise, and how much came from the combination.
The trial was intensive and may not be easy to reproduce in routine care
The intervention required a level of support that is more intensive than standard diabetes care. Participants received meal-replacement products, dietitian and medical follow-up, and supervised exercise sessions during the first 12 weeks.
That matters when considering how widely the results can be applied. A program that works under closely monitored trial conditions may be harder to sustain in routine clinical practice, particularly for people balancing work, childcare, cost and access to exercise facilities.
The trial also enrolled a selected population: adults younger than 46 with obesity, relatively early type 2 diabetes and no insulin treatment. The results therefore should not be generalized automatically to older adults, people with long-standing diabetes, people using insulin, or people without obesity.
Six months is too short to know how durable the remission will be
The biggest unanswered question is durability.
RESET for Remission measured its primary outcome at 24 weeks. That is enough to demonstrate that remission can occur, but not enough to establish how many people will remain in remission one, two or five years later.
Longer-term studies of diabetes remission have consistently shown that maintaining weight loss is central to maintaining remission. Weight regain can be followed by a return of hyperglycemia.
That distinction is especially important because headlines sometimes describe diabetes remission as “reversal.” Remission is the more accurate term. The disease can become inactive by current biochemical criteria, but the underlying susceptibility has not necessarily disappeared.
The results provide a non-drug remission option for some younger adults
The study arrives during a period of rapid change in diabetes treatment. Drugs such as GLP-1 receptor agonists and dual incretin therapies can produce substantial weight loss and improve glucose control, and newer agents such as retatrutide are being tested in large phase 3 programs.
At the same time, randomized trials continue to show that substantial weight loss achieved through intensive lifestyle intervention can also lead to remission in selected patients.
These approaches are not necessarily competitors. Some people may prefer an intensive diet-and-exercise program, some may need medication, and others may ultimately use both. The appropriate strategy depends on diabetes duration, body weight, other medical conditions, medication tolerance, access and personal preference.
For people considering aggressive calorie restriction, medical supervision matters. An 800-900 kcal/day diet is not a routine do-it-yourself diet, particularly for people taking glucose-lowering or blood-pressure medications, because medication doses may need to change rapidly as glucose and blood pressure fall.
The trial supports remission as a realistic treatment goal in early disease
The most important message from RESET for Remission is that early-onset type 2 diabetes is not inevitably progressive in the short term. In a carefully selected group of younger adults, an intensive six-month diet-and-exercise program produced remission in more than half of participants.
What remains unknown is how durable that remission will be and whether the same results can be achieved at scale outside a research program.
The next phase of the evidence will need to answer those practical questions: who benefits most, how much support is required, whether structured exercise adds benefit beyond diet-induced weight loss, and how remission can be maintained over years rather than months.
References
- Dasgupta K, Boulé 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. 2026:101664. DOI: 10.1016/j.lana.2026.101664.
- Dasgupta K, Boulé N, Henson J, et al. Remission of type 2 diabetes and improved diastolic function by combining structured exercise with meal replacement and food reintroduction among young adults: the RESET for REMISSION randomised controlled trial protocol. BMJ Open. 2022;12:e063888. DOI: 10.1136/bmjopen-2022-063888.
- Luk A, Wild SH, Jones S, et al. Early-onset type 2 diabetes: the next major diabetes transition. The Lancet. 2025;405:2313-2326. DOI: 10.1016/S0140-6736(25)00830-X.