A rigorous randomised trial presented at the Annual Meeting of the European Association for the Study of Diabetes in Milan and published in The Lancet Regional Health Americas has delivered one of the most encouraging results yet in the fight against early onset type 2 diabetes. Researchers led by Professor Kaberi Dasgupta, Director of the Division of General Internal Medicine at McGill University in Montreal, and Professor Thomas Yates of the University of Leicester, together with colleagues, found that roughly half of adults under 45 living with the condition achieved complete remission after 24 weeks on a programme combining a low energy diet with structured exercise. In the intervention group, 27 of 50 participants, or 54 percent, reached remission, compared with just 2 of 46, or 4 percent, in the usual care group. After statistical adjustment, those following the combined programme were 21 times more likely to attain remission than those receiving standard care.
Early onset type 2 diabetes, abbreviated EOT2D, is increasingly recognised by clinicians as a distinct and particularly aggressive clinical phenotype. Because it strikes in the third and fourth decades of life, the disease has decades longer to inflict damage on blood vessels, nerves, kidneys and the heart. People diagnosed young experience more rapid deterioration in blood sugar control, develop complications earlier, and face a lower life expectancy than those whose type 2 diabetes appears later in life. As rates of obesity rise across the globe, the number of young adults affected is climbing steeply, making the search for potent, disease-modifying interventions an urgent priority for health systems worldwide.
The biological rationale behind the trial, known as RESET for Remission, rests on the complementary effects of dietary energy restriction and exercise. Low energy diets have previously been shown to drive glucose levels below the diagnostic threshold for type 2 diabetes without the need for medication, a state defined as remission. Adding structured exercise may deliver synergistic advantages: greater cardiorespiratory fitness, preservation of muscle mass during rapid weight loss, enhanced cardiac function, and reduced insulin resistance. The researchers reasoned that a condition as aggressive as early onset type 2 diabetes merits an intervention powerful enough to arrest its swift evolution, and they designed the study to test whether combining the two approaches would outperform usual care.
The trial was a randomised, open-label, blinded endpoint efficacy study conducted across three centres in England and Canada, affiliated with the University of Leicester, McGill University in Montreal, and the University of Alberta in Edmonton. It enrolled adults aged 18 to 45 with early onset type 2 diabetes and obesity who were not taking insulin therapy. Between September 24, 2021 and June 6, 2025, a total of 96 participants were randomised, 40 in the United Kingdom and 56 in Canada. The intervention group comprised 24 women and 26 men, while the control group had 21 women and 25 men. The mean age of participants was 38 years and the mean body mass index was 35.2 kilograms per square metre. Notably, 86 participants, or 90 percent, attended final assessments, a retention rate that strengthens confidence in the findings.
The intervention itself was demanding but carefully structured. Participants stopped all glucose-lowering and blood pressure-lowering medication, in the absence of albuminuria, as they began an 800 to 900 kilocalorie per day diet providing 30 percent of energy from protein, 50 percent from carbohydrate and 20 percent from fat. They were encouraged to drink at least two litres of calorie-free fluid daily and were given a fibre-based laxative to use as required. The first two weeks consisted of total meal replacement using Optifast. From weeks 3 to 12, the same caloric intake continued with more variety, using Optifast in the United Kingdom and ProtiDiet in Canada, alongside one food-based meal per day supplying 60 to 90 grams of protein from all sources combined, one portion of fruit and two portions of non-starchy vegetables.
Exercise ran in parallel with the dietary phase. During weeks 1 to 12, participants completed twice-weekly supervised sessions covering both aerobic and resistance training, plus one weekly independent exercise session. From weeks 13 to 24, they transitioned to a weight-maintenance diet while continuing independent exercise. The primary outcome was remission at 24 weeks, defined as a glycated haemoglobin level below 6.5 percent, or 48 millimoles per mole, together with the absence of glucose-lowering medication for at least 12 weeks. The primary efficacy and harms analysis included all randomised individuals, with a conservative assumption that missing data meant no remission. Secondary endpoints captured cardiorespiratory fitness, body composition and cardiac structure.
The results were striking across multiple dimensions. Intervention participants, who averaged 100.7 kilograms at baseline, lost a mean of 8.4 kilograms by week 24, reaching an average weight of 92.3 kilograms. Control participants, who averaged 103.2 kilograms at the start, lost only 1.2 kilograms, ending at a mean of 102.0 kilograms. After statistical adjustment, the analysis showed that intervention participants lost 7.5 kilograms more than controls, including 6.6 additional kilograms of fat mass. Critically, the trial demonstrated that fat-free mass and muscle preservation are achievable even during rapid weight loss, a finding the authors attribute to the resistance training component that deliberately targeted muscle during the intensive dietary phase.
Safety data were reassuring. Remission was achieved without any severe adverse events. Most participants in the intervention group, 43 of 50, experienced at least one adverse event, compared with 6 of 46 in the control group, but these were mainly the familiar early effects of very low energy diets, such as constipation, headache, dizziness and fatigue, all of which resolved. This profile mirrors what has been reported in previous meal replacement trials and suggests that, under appropriate supervision, the intervention is tolerable for the majority of young adults willing to undertake it.
The authors emphasised the breadth of the benefits beyond blood sugar control. In their summary of the RESET for Remission findings, they report that combining structured aerobic and resistance exercise with a low-calorie diet produced high remission rates, induced fat loss while preserving muscle mass, improved muscle quality and function, enhanced cardiovascular health, and led to meaningful improvements in patient-reported outcomes. They noted that their remission rates sit at the upper end of those previously reported in the literature for trials of similar duration, and that this is the first time such effects have been demonstrated in a multi-ethnic population with early onset type 2 diabetes through a combined low energy diet and structured exercise intervention.
The researchers are candid about the challenges that remain. All weight loss programmes, including low energy diets used for type 2 diabetes remission, are typically followed by a period of partial or full weight regain for most people. Because weight loss driven by lower energy intake alone reduces both fat and fat-free mass, and there is some evidence that weight regain may preferentially restore fat over fat-free mass, there is a long-term risk of net muscle loss and increased sarcopenia. Preserving muscle during remission-oriented weight loss, they argue, may have important implications for long-term metabolic health, physical function and disease trajectory, though this requires confirmation in longer-term studies. They also highlight that their approach may be particularly valuable for those seeking or with potential for pregnancy, a group in which medication options are limited. As the global prevalence of early onset type 2 diabetes continues to rise, the team concludes that the findings present an opportunity to re-evaluate treatment paradigms and support scalable implementation of integrated dietary and exercise interventions, pending further evaluation in real-world settings.
Subject of Research: Remission of early onset type 2 diabetes through a combined low energy diet and structured exercise intervention
Article Title: Study shows low energy diet combined with structured exercise reverses early onset type 2 diabetes in half of participants
Article References: Study shows low energy diet combined with structured exercise reverses early onset type 2 diabetes in half of participants. (n.d.). Original publication
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DOI: Not provided
Keywords: type 2 diabetes, diabetes remission, low energy diet, structured exercise, early onset diabetes, randomised controlled trial, weight loss, resistance training, McGill University, University of Leicester, EASD, The Lancet Regional Health Americas
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Daisy Hatcher. (October 1, 2026). Diet and Exercise Combo Puts Early Type 2 Diabetes Into Remission in Half of Young Adults. Scienmag. https://scienmag.com/diet-and-exercise-combo-puts-early-type-2-diabetes-into-remission-in-half-of-young-adults/
Daisy Hatcher. “Diet and Exercise Combo Puts Early Type 2 Diabetes Into Remission in Half of Young Adults.” Scienmag, 1 October 2026, https://scienmag.com/diet-and-exercise-combo-puts-early-type-2-diabetes-into-remission-in-half-of-young-adults/. Accessed 1 October 2026.
Daisy Hatcher. “Diet and Exercise Combo Puts Early Type 2 Diabetes Into Remission in Half of Young Adults.” Scienmag. October 1, 2026. https://scienmag.com/diet-and-exercise-combo-puts-early-type-2-diabetes-into-remission-in-half-of-young-adults/
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