Low-Calorie Diet, Exercise Reversed Type 2 Diabetes Without Meds

TL;DR

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The RESET for Remission trial found that 54% of participants assigned to a low-calorie meal-replacement diet and structured exercise met the study’s definition of diabetes remission at 24 weeks, compared with 4% receiving usual care. The result applies to adults ages 18 to 45 with relatively recent-onset type 2 diabetes; researchers say further work is needed to establish the added contribution of exercise.

A 12-week low-calorie meal-replacement diet paired with supervised exercise, followed by a 12-week maintenance program, put 54% of participants with early-onset type 2 diabetes into remission at 24 weeks, researchers reported. In the randomized RESET for Remission trial, remission was recorded in 4% of those receiving usual care, a difference that suggests an intensive lifestyle program may help some younger adults reach diabetes remission without glucose-lowering medication during the period specified by the study.

The trial enrolled 96 adults ages 18 to 45 whose type 2 diabetes had been diagnosed within the previous six years. Participants had a baseline HbA1c averaging 7.2%. Researchers randomly assigned them in equal numbers to the intervention or routine clinical care. At the start of the study, 74% were taking metformin, 20% an SGLT2 inhibitor, and a small minority a GLP-1 drug.

For the first 12 weeks, the intervention group followed a daily 800- to 900-calorie meal-replacement diet, attended supervised aerobic and resistance exercise twice a week, and exercised independently once a week. The next 12 weeks focused on maintaining changes with a nutritionally optimized diet, fewer meal replacements and independent exercise. The study defined remission as an HbA1c below 6.5% without glucose-lowering medication for at least 12 weeks.

Ninety percent completed their final assessment. The research team counted participants who did not complete the study as not having achieved remission. No serious adverse events were reported. Common effects included temporary headaches, constipation, dizziness and fatigue when starting the diet; mild infections were slightly more frequent in the intervention group.

Remission Results in Younger Adults

Early-onset type 2 diabetes can expose people to elevated blood glucose and potential complications during working and family-building years. Study investigator Kaberi Dasgupta of McGill University said complications may arise as people start a family, relationship or job. The trial tested an intensive approach in this younger population, rather than assuming results from studies of older adults apply directly.

The 54% remission rate compared with 4% under usual care is the central finding, but it describes outcomes at 24 weeks under a particular program and definition. It does not establish that remission will last after the study period or that participants can safely stop medication outside clinical supervision. The result may give clinicians and patients evidence to discuss structured diet and exercise as one possible approach, while individual suitability and follow-up remain matters for care teams.

Researchers also reported changes beyond HbA1c. Intervention participants had greater improvements in handgrip strength, blood pressure, resting heart rate, triglycerides, quality of life, depression symptoms and diabetes distress. More reached hypertension remission than in usual care, 56% compared with 27%. These are trial findings; the report does not establish how long those differences persist.

How the RESET Program Worked

Low-energy meal-replacement diets have been studied as non-surgical ways to support diabetes remission. The RESET trial addressed a narrower question: whether such a diet combined with structured, supervised exercise could work for adults with diabetes diagnosed before age 45. The trial was open-label, meaning participants and researchers knew which group participants had entered.

Body-composition measures offered another comparison. Yates said the intervention produced less total weight loss than figures reported for tirzepatide in the separate SURPASS-3 trial: 16.5 pounds at 24 weeks in RESET versus 28.4 pounds at 52 weeks in SURPASS-3. Those results come from different trials and time windows, so they are not a direct head-to-head test. RESET researchers also reported greater reductions in visceral fat and liver fat fraction, alongside MRI-measured changes in fat in the pancreas, abdomen and thighs.

““Even though it was a big ask, people liked it, they liked the exercise, and they stayed in the study.””

— Kaberi Dasgupta, MD, MSc, of McGill University, speaking at the EASD annual meeting

What the Trial Cannot Resolve

The trial tested the diet and exercise program together, so it cannot show how much remission was attributable to the diet, the exercise or their combination. Yates said more research is needed to establish the added benefit of exercise. The study was also relatively small, with 96 participants, and its reported outcome was measured at 24 weeks.

It is not yet clear how many participants will remain in remission over a longer period, whether the results apply to people outside the ages and diagnosis window studied, or how the program compares with medication in a direct trial. The report gives subgroup results by sex, ethnicity and country as consistent, but those analyses do not by themselves establish equal effects in every population. No serious adverse events were reported in this trial; the sample and follow-up cannot settle every question about safety for broader use.

Longer Follow-Up and Exercise Trials

The findings were presented at the European Association for the Study of Diabetes annual meeting in Milan and published at the same time in Lancet Regional Health Americas. The next research questions include whether remission lasts beyond 24 weeks and whether a study that separates diet and exercise can measure the added effect of each component.

For now, the results describe a supervised program delivered in a trial. Anyone considering a very low-calorie diet or a major change in exercise should discuss it with a qualified health professional, particularly when taking diabetes medication or managing other health conditions. The trial does not establish that participants should change or stop medication without medical guidance.

Key Questions

What did the study mean by diabetes remission?

It meant an HbA1c below 6.5% without glucose-lowering medication for at least 12 weeks, according to the trial’s definition.

How many participants reached remission?

At 24 weeks, 54% of the intervention group met the study definition, compared with 4% of the usual-care group.

What did the intervention involve?

Participants followed an 800- to 900-calorie daily meal-replacement diet for 12 weeks, with supervised exercise twice weekly and independent exercise once weekly. A 12-week maintenance period followed.

Does the trial show that exercise caused the higher remission rate?

No. Diet and exercise were delivered together, so the study could not isolate exercise’s added effect. Investigator Thomas Yates said further research is needed on that question.

Can people stop diabetes medication based on these findings?

The study does not advise people to stop medication on their own. Medication changes should be discussed with a qualified health professional who can consider a person’s health and treatment.

Source: rss