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In the RESET for Remission trial, 54% of young adults assigned a low-calorie meal-replacement diet and structured exercise met the study’s diabetes-remission definition at 24 weeks, compared with 4% receiving usual care. The result applies to a small group with early-onset type 2 diabetes; researchers say further study is needed to establish the added contribution of exercise.
A structured low-calorie diet and exercise program put type 2 diabetes into remission at 24 weeks for 54% of participants in a randomized trial of young adults, compared with 4% assigned to usual care. The RESET for Remission findings, presented at the European Association for the Study of Diabetes meeting in Milan and published in Lancet Regional Health Americas, offer evidence for a non-surgical approach in people with early-onset diabetes, but do not show that the condition is permanently cured.
The trial enrolled 96 adults aged 18 to 45 whose type 2 diabetes had been diagnosed within the previous six years. Participants were assigned in equal numbers to the intervention or routine clinical care. Remission was defined as an HbA1c below 6.5% without glucose-lowering medication for at least 12 weeks. At 24 weeks, the reported remission rates were 54% and 4%, respectively; the adjusted odds ratio was 21.6, with a 95% confidence interval of 6.2 to 114.5.
For the first 12 weeks, the intervention combined an 800-to-900-calorie daily meal-replacement diet with supervised aerobic and resistance exercise twice a week and independent exercise once a week. A further 12-week maintenance phase used a nutritionally optimized diet, gradually reduced meal replacements and independent exercise. The study was open-label, meaning participants and researchers knew which group each person was in.
About 90% completed the final assessment. No serious adverse events were reported. Researchers recorded temporary symptoms when participants started the diet, including headaches, constipation, dizziness and fatigue, as well as a slightly higher rate of mild infections in the intervention group. The study also reported improvements in measures including body-fat distribution, handgrip strength, blood pressure, triglycerides and quality of life; these are trial findings, not proof of long-term health outcomes.
A Remission Option for Younger Adults
Type 2 diabetes diagnosed at a younger age can mean living with the condition for more years, during which complications may develop. The trial tested whether a structured program could produce remission in this group, rather than relying only on routine clinical care. Its results suggest that remission is possible for some participants without glucose-lowering medication during the defined assessment period.
The findings also provide evidence on a practical question: whether people can follow an intensive diet while taking part in regular supervised exercise. High study completion suggests many enrolled participants remained in the program, although it does not establish that the approach is manageable or appropriate for everyone. The researchers reported benefits beyond total weight loss, including changes in fat measures and physical and psychological outcomes. Those measures may help inform future research, but they do not show that exercise itself caused the difference in remission.
This is not a basis for stopping medication or starting a very-low-calorie diet without medical oversight. The intervention was structured and monitored, and the trial involved a specific age group and disease history. Any changes to diabetes treatment or eating and exercise plans should be discussed with a qualified health professional.
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How the Trial Was Designed
Participants had baseline HbA1c levels from 6.5%—or 6.0% for those taking medication—to 10.0%; the group average was 7.2%. At the start, 74% were taking metformin, 20% an SGLT2 inhibitor and a small minority a GLP-1 drug. The study focused on early-onset type 2 diabetes, defined by the researchers as diagnosis before age 45.
Low-energy meal-replacement diets had already been studied as non-surgical approaches to diabetes remission. The researchers said fewer studies had tested this method alongside structured, supervised exercise. The trial’s design combined both components, so its comparison with usual care cannot isolate how much of the outcome came from the diet, exercise or their combination.
Study co-investigator Thomas Yates compared the trial’s weight-loss result with results from a separate tirzepatide study, but the trials differed in duration and design. The RESET participants lost an average of 16.5 pounds at 24 weeks; the cited SURPASS-3 result was 28.4 pounds at 52 weeks. That cross-trial comparison does not establish that one approach is more effective than the other.
““It’s already quite a lot to ask someone to adhere to a meal-replacement diet. Adding supervised exercise makes it even more challenging.””
— Kaberi Dasgupta, MD, MSc, of McGill University, speaking at the EASD meeting
What the 24-Week Results Cannot Show
The results describe outcomes at 24 weeks; they do not establish whether remission lasts after the program or whether participants later need medication again. The trial had only 96 participants, and the reported confidence interval around the adjusted odds ratio was wide. Its results may not apply to older adults, people with longer-standing diabetes or people whose health circumstances differ from those of the participants.
Because the study tested a combined diet-and-exercise program against routine care, it cannot determine how much exercise added to the effect of the diet. The source report also does not establish whether the program is affordable, widely available or sustainable outside a trial. Researchers reported no serious adverse events, but temporary symptoms and mild infections occurred; a small study cannot rule out every possible risk.
Further Research on Exercise and Durability
Researchers have called for further studies to test the added contribution of exercise and to examine whether remission persists beyond the 24-week assessment. Longer follow-up would also help show how often participants resume glucose-lowering medication and whether the reported changes in health measures continue. Until those results are available, the trial supports a short-term finding in a defined group, not a claim of permanent reversal.
Key Questions
What did the trial mean by diabetes remission?
It defined remission as HbA1c below 6.5% without glucose-lowering medication for at least 12 weeks. This is a study definition and does not mean the disease was permanently cured.
How many participants reached remission?
At 24 weeks, 54% in the intervention group met the remission definition, compared with 4% receiving usual care. The trial included 96 participants in total.
What did the intervention involve?
It included an 800-to-900-calorie daily meal-replacement diet, supervised aerobic and resistance exercise twice weekly, and independent exercise once a week for 12 weeks, followed by a 12-week maintenance phase.
Does the study show that exercise alone caused remission?
No. Participants received diet and exercise together, and the comparison group received usual care. The design cannot separate the effect of exercise from the diet or confirm the added benefit of exercise.
Should people with type 2 diabetes stop medication or try this diet?
The trial does not support stopping medication without clinical advice. Its intensive diet and exercise plan was studied in a monitored setting; anyone considering changes to treatment or diet should speak with a health professional.
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