Half reached remission in six months
A structured programme of low-energy meal replacements and supervised exercise put type 2 diabetes into remission for 54% of younger adults within 24 weeks, according to a randomised trial published in the Lancet Regional Health - Americas. The comparison group, which received usual care, had a 4% remission rate over the same period.
Remission was defined as an HbA1c below 6.5% without any glucose-lowering medicine for at least 12 weeks. The adjusted odds ratio was 21.6, with a wide confidence interval of 6.2 to 114.5, reflecting the small size of the trial.
Who took part
The study, called RESET for Remission, enrolled 96 people with early-onset type 2 diabetes, a group that has grown as diagnosis shifts toward younger adults. Participants were randomly assigned to the intensive programme or to usual care, and outcomes were assessed by clinicians who did not know which group each person was in.
The intervention combined a low-calorie diet, partly built on meal replacements, with exercise sessions supervised by staff. Weight loss was substantial in the treatment arm, and researchers say that loss, rather than the exercise alone, is the main driver of remission in early diabetes.
The hard part is sticking with it
Clinicians not involved in the trial noted that the programme asks a lot. Meal-replacement diets are hard to sustain, and adding supervised exercise raises the burden further. The question is whether health systems can offer the same intensity of support outside a research setting, where drop-out rates tend to be higher.
One of the investigators said the results suggest that people who can adhere stand to gain both the weight loss and the remission, and possibly the separate benefits of exercise on heart and muscle health. The team is now following participants to see how many stay in remission after the programme ends.
For patients, the practical message is that early type 2 diabetes is not always a one-way progression. The trial does not show that diet and exercise replace medication for everyone, and people with longer-standing diabetes or other conditions were not included.