A structured programme combining a low-energy diet with regular exercise has helped more than half of younger adults with type 2 diabetes achieve remission in a new clinical trial, recently published in The Lancet Regional Health Americas.
The finding offers hope for people diagnosed with type 2 diabetes at an earlier age, a form of the condition often linked to faster health decline and a greater lifetime risk of complications. These can include heart disease, kidney damage, nerve problems and sight loss.
After 24 weeks, 54% of participants following the intensive diet-and-exercise programme achieved diabetes remission. In comparison, only 4% of participants receiving usual care met the same target.
The research involved 96 adults aged 18 to 45 with early-onset type 2 diabetes and obesity. It was conducted across centres in England and Canada connected with the University of Leicester, McGill University and the University of Alberta. Participants were not using insulin when they joined the study.
Scientists randomly divided the group into two arms. One received standard diabetes care. The other completed a closely monitored intervention that included a low-energy diet, supervised exercise, independent activity and a weight-maintenance phase.
The study defined remission as an HbA1c level below 6.5%, without diabetes medication for at least 12 weeks. HbA1c is a blood test that estimates average glucose levels over the previous two to three months. A result below 6.5% is below the usual threshold for diagnosing diabetes.
The intervention began with a strict diet providing 800 to 900 calories a day. It included 30% protein, 50% carbohydrates and 20% fat. For the first two weeks, participants consumed meal-replacement products only. From week three, they continued within the same calorie allowance while adding one meal made from ordinary foods each day.
These meals included protein sources, one portion of fruit and two portions of non-starchy vegetables. Participants were asked to drink at least two litres of calorie-free fluids each day. They could also receive a fibre-based laxative if constipation became a problem.
This was not a typical low-calorie diet undertaken alone at home. It was a carefully managed clinical programme. Researchers reviewed participants regularly, monitored their health and adjusted treatment where needed.
At the start of the programme, participants stopped diabetes and blood-pressure medicines unless there was a clinical reason to continue them. One exception was albuminuria, a sign of kidney involvement where increased albumin is present in the urine. Medication changes were supervised because blood glucose and blood pressure can fall rapidly during substantial weight loss.
Exercise formed a key part of the intervention. For the first 12 weeks, participants attended two supervised aerobic and resistance-training sessions each week. They also carried out one independent session. From weeks 13 to 24, they moved to a weight-maintenance diet and continued exercise independently.
Aerobic activity improves cardiovascular fitness and helps the body use glucose more effectively. Resistance exercise can preserve muscle mass, improve strength and support long-term metabolism. This combination may be especially useful during weight loss, when lean tissue can otherwise be lost alongside fat.
Weight loss was far greater in the intervention group than in the usual-care group. Those following the diet-and-exercise programme lost an average of 8.4 kilograms over 24 weeks. Participants receiving usual care lost 1.2 kilograms on average.
After researchers accounted for relevant differences between individuals, the intensive programme produced approximately 7.5 kilograms more weight loss than usual care. Most of this loss was fat mass. The intervention group lost around 6.7 kilograms of body fat by the end of the study.
This matters because excess fat stored in and around key organs, including the liver and pancreas, can contribute to insulin resistance. Insulin resistance occurs when the body’s cells do not respond effectively to insulin, the hormone that helps move glucose from the blood into cells for energy. Over time, the pancreas may struggle to produce enough insulin to compensate.
Researchers also found that participants largely maintained muscle mass during their weight loss. That may be one of the most important features of the programme. Preserving muscle supports mobility, strength, independence and metabolic health. Adequate protein intake and resistance exercise may help protect lean tissue while fat is being reduced.
Early-onset type 2 diabetes is a growing concern. People diagnosed in their twenties, thirties or early forties can face decades of living with high blood glucose. The condition may progress faster in younger adults than in people diagnosed later in life. This makes early treatment particularly important.
The study supports an increasingly recognised view that type 2 diabetes does not always follow an unavoidable path of worsening blood glucose and escalating medication. Some people can achieve remission, especially when diabetes has been present for a shorter period and when significant weight loss is possible.
Remission is not the same as a cure. A person remains at risk of diabetes returning, particularly if weight is regained. Long-term follow-up is also needed to establish whether participants can sustain both their weight loss and their lower glucose levels. Still, remission can be a meaningful health outcome. It may reduce the need for medication and lower the risk of diabetes-related complications.
The trial’s results should be interpreted carefully. An intake of 800 to 900 calories a day is highly restrictive. It is not suitable for everyone, and it should not be started without professional advice. Very low-energy diets can cause side effects, especially in the early stages.
Most people in the intervention group reported symptoms such as constipation, headache, dizziness and fatigue. These effects were mostly mild and improved over time. However, the risks may be greater for people taking diabetes medicines, blood-pressure treatment or drugs that affect fluid balance.
A sharp fall in calorie intake can quickly change blood glucose levels. For someone taking certain glucose-lowering medicines, this may raise the risk of hypoglycaemia, also known as low blood sugar. Blood-pressure medicines may also need adjustment if weight loss reduces blood pressure. Clinical monitoring is therefore essential.
The wider message from the study is not that every person with type 2 diabetes needs meal replacements or a medically supervised very low-energy diet. It is that meaningful weight loss, physical activity and sustained support can produce powerful metabolic changes.
For many people, a more moderate approach may be more realistic. Dietitians often suggest reducing calorie intake by roughly 500 to 700 calories a day, where appropriate, aiming initially to lose at least 5% of starting body weight. Individual needs vary, so a personalised plan is more likely to be safe and sustainable.
Food quality also matters. Lower calorie intake alone does not guarantee a nourishing diet. Experts recommend prioritising vegetables, fruit, beans, lentils, wholegrains, lean protein sources and unsaturated fats. Fibre-rich foods can support digestion and help people feel fuller for longer. Limiting ultra-processed foods may make it easier to manage appetite and improve overall nutrition.
Exercise can begin with simple, accessible choices. Public-health guidance commonly recommends at least 150 minutes of moderate-intensity activity each week. This can include brisk walking, cycling, swimming, dancing, gardening or active household tasks. Shorter sessions can still add up.
Strength training is also valuable. It can involve gym equipment, resistance bands, bodyweight exercises or supervised classes. For people new to activity, starting slowly is sensible. A brief walk after a meal or a short home exercise routine can be a practical first step.
The study also highlights the importance of making lifestyle goals specific and measurable. Recording meals, activity and weight trends can help people identify what works. It can also reveal patterns, such as stressful situations or routines that make healthy choices more difficult.
Regular contact with healthcare professionals remains important. Blood glucose, HbA1c, blood pressure, kidney function and medication needs may shift as weight changes. Anyone considering major dietary restriction should speak with a GP, diabetes nurse, dietitian or specialist first.
The research included participants from a multi-ethnic population, increasing its relevance across diverse communities. Yet questions remain. Researchers need longer-term evidence on whether remission lasts, how easily people can maintain these changes and whether such programmes can be offered widely through routine healthcare services.
Access is another issue. Meal replacements, supervised exercise and frequent clinical reviews may not be available to every patient. Health services will need practical, affordable ways to adapt effective programmes for real-world use.
For younger adults living with type 2 diabetes, the findings offer a clear and encouraging message. Intensive lifestyle support may not simply improve diabetes control. In some cases, it may make remission possible.
Medication remains essential for many people and should never be stopped without clinical guidance. However, this trial shows that a carefully supervised combination of calorie reduction, exercise and ongoing support can create a meaningful opportunity for better health.
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