Trial: 54% of young adults with type 2 diabetes reached remission after 24 weeks of low-calorie diet and supervised exercise

A small randomized trial found that a strict, medically supervised program of meal replacements and exercise put type 2 diabetes into remission for more than half of young adults who tried it. Usual care did almost nothing by comparison.

The RESET for Remission trial was published in The Lancet Regional Health - Americas and presented at the European Association for the Study of Diabetes annual meeting in Milan.

What the trial found

Researchers at McGill University, the University of Leicester and the University of Alberta enrolled 96 adults aged 18 to 45. All had obesity and early-onset type 2 diabetes. None used insulin.

The average age was 38 and the average body mass index was 35.2. Forty participants were from the United Kingdom and 56 from Canada. They were randomized between September 24, 2021, and June 6, 2025.

At 24 weeks, 27 of 50 people in the intensive group (54%) had reached remission. In the usual-care group, 2 of 46 (4%) did. After statistical adjustment, the intensive group was about 21 times more likely to reach remission.

Remission was defined as an HbA1c below 6.5% with no glucose-lowering medication for at least 12 weeks. That is the consensus definition. It is not a cure.

How the program worked

Participants in the intervention group stopped their blood sugar and blood pressure medications under medical supervision when the diet began. They then ate 800 to 900 calories a day.

For the first two weeks, that meant meal replacements only. The trial used Optifast products, split roughly 30% protein, 50% carbohydrate and 20% fat. From weeks three through 12, participants added one structured meal a day of lean protein and vegetables. From weeks 13 to 24, they moved to a food-based diet meant to hold their weight steady.

Exercise was built in from the start: two supervised aerobic and resistance sessions a week, plus one workout on their own.

The design was deliberate. Rapid weight loss often strips muscle along with fat, and some research suggests regained weight can return disproportionately as fat. Resistance training was meant to head that off.

"In our study, we think the diet provoked the weight loss, and exercise helped make sure it was [not] from muscle," lead author Dr. Kaberi Dasgupta, director of the Division of General Internal Medicine at McGill, told Fox News Digital.

The intensive group lost about 7.5 kg more than the usual-care group, according to the McGill University Health Centre. Whole-body MRI scans showed improvements in pancreatic fat fraction, according to MedPage Today.

Why younger adults

Type 2 diabetes diagnosed before 45 tends to progress faster than diabetes diagnosed later. Patients face quicker loss of blood sugar control, earlier cardiovascular complications and shorter life expectancy, according to the medical literature the researchers cite.

The trial's authors wrote that their remission rates are "at the upper end of those previously reported in the literature for trials of similar duration." They also said it was the first demonstration that such effects can be achieved in a multi-ethnic population with early-onset type 2 diabetes using a combined low-energy diet and structured exercise program.

Adherence, and the limits

Dasgupta said there had been concern that combining a severe diet with exercise would be too much for patients. "However, people in our study stayed in our study," she said.

Only 10% of participants missed the final evaluations. Patients attended a median of 17 of 20 scheduled supervised gym sessions. Those who did not complete the final assessment were counted as not in remission, so the 54% figure is conservative on that point.

The limits are plain. This was 96 people across three sites, followed for six months. Participants knew which group they were in, so the trial was open-label, though the people assessing the endpoints did not know the assignments.

The participants were also under supervision, with medical oversight, supervised gym sessions and provided meal replacements. That is a different setting from a patient trying this alone, and the trial did not test an unsupervised version.

Remission here also depends on keeping the weight off. If the weight returns, blood sugar can climb back into the diabetic range. The 24-week endpoint says nothing about what happens at one year or five.

What comes next

The trial ended its intervention at 24 weeks. Whether remission holds after the supervised program stops, and whether health systems will pay for meal replacements and supervised training for patients under 45, are the questions the data cannot yet answer. Neither the authors nor the sponsoring institutions have announced a longer follow-up result.