More than half the people enrolled in a combined low-calorie eating and exercise regimen had achieved type 2 diabetes remission by the 24-week mark, with their muscle mass remaining intact throughout.

Among those who receive a diagnosis before turning 45, preserving muscle mass represents an added layer of complexity in managing a form of the disease that tends to advance more rapidly, bring on complications at a younger age, and reduce overall life expectancy relative to diabetes that appears in later years.

Within the RESET for Remission trial, a team drawn from three research sites spanning England and Canada combined a heavily restricted intake of 800 to 900 calories daily with a supervised exercise programme, targeting both conditions at once. At the 24-week mark, just over half of those enrolled — 27 out of 50 participants, or 54% — had their blood sugar drop below the diagnostic threshold for diabetes without relying on any glucose-lowering medication, meeting the criteria for remission. Of the 46 people assigned to standard treatment, just two — a rate of 4% — went on to reach remission.

Among the researchers involved were Kaberi Dasgupta, who holds a professorship and leads the Division of General Internal Medicine at McGill University in Montreal, Quebec, and Thomas Yates, a professor based at the University of Leicester in the United Kingdom. Collaborative work unfolded across the trial's three participating centres — one connected to McGill, another to Leicester, and a third to the University of Alberta in Edmonton, Canada — drawing on the expertise of staff at each location.

Ninety-six participants were divided by random allocation into either the combined programme or standard care, with enrolment running from late September 2021 through early June 2025. Each participant fell within the 18-to-45 age bracket, carried a diagnosis of early-onset type 2 diabetes alongside obesity, and managed their condition without insulin therapy. Of the 96 participants enrolled, 40 held UK residency while the remaining 56 were based in Canada.

Participants in the study carried a mean body mass index of 35.2 kg/m², with their ages centring around 38 years. Of the 96 people enrolled, 50 joined the intervention arm — split between 24 women and 26 men — while the remaining 46, comprising 21 women and 25 men, continued with standard care. Those enrolled in the trial were told which treatment they had been assigned, giving the study an open-label design, while the personnel responsible for evaluating the pre-specified endpoints had no access to that assignment information.

Across the two-week opening phase, participants in the intervention arm drew all of their daily nutrition from meal-replacement products. The trial's authors reported that remission rates in their cohort landed toward the upper range of what peer studies of comparable duration have recorded, with the combined regimen of calorie-restricted meal replacements and supervised physical activity having generated those outcomes, according to the published record, within a multi-ethnic cohort of people presenting with early-onset type 2 diabetes — a pattern the authors described as adding to the body of evidence that structured lifestyle interventions can produce remission with measurable clinical relevance.

Each day, roughly 800 to 900 calories were consumed, with protein accounting for about three-tenths of that total, carbohydrates making up half, and fat covering the remaining fifth. As part of the trial protocol, those enrolled halted their glucose-lowering and blood pressure-lowering drugs at the point the dietary intervention started, provided no albuminuria — a condition marked by albumin protein appearing in the urine — had been detected.

Starting in the third week, those taking part gained the freedom to diversify their food choices while keeping their calorie intake at the same level through to week 12. Dietary protein intake across all sources was set at a combined target of 60 to 90 grams, alongside a single serving of fruit and two servings of vegetables low in starch. Each study participant was advised to take in a minimum of two litres of calorie-free fluid throughout the day, with a fibre-based laxative made available for use whenever needed.

During that opening 12-week stretch, study participants kept to the restricted diets while also fitting in two exercise sessions led by supervisors and a third workout they carried out on their own each week. Pairing aerobic work with resistance training, the supervised regimen was designed to build on the dietary component by bolstering cardiovascular function, maintaining lean mass, and lowering the body's resistance to insulin. Insulin resistance is the term used when the body's own cells lose their ability to respond properly to insulin, the hormone responsible for regulating blood sugar levels.

Between weeks 13 and 24, those taking part moved onto a weight-maintenance eating plan while keeping up their exercise routines on their own. Glycated hemoglobin — commonly called HbA1c, a marker that tracks average blood glucose over time — served as the tool for gauging remission once the programme wrapped up. To qualify for enrolment, individuals needed a glycated haemoglobin reading under 6.5% — the equivalent of 48 millimoles per mole — and a minimum three-month period free from any medication designed to lower blood glucose.

Of the 86 people enrolled in the study, nine out of ten completed the closing round of assessments. All participants who had been randomly assigned were drawn into the team's core analyses covering both outcomes and adverse events, with any gaps in remission data treated as non-remission for the purposes of those calculations. Following statistical controls, the combined programme's participants showed remission odds roughly 21 times higher than those of individuals in standard treatment.

Cardiac structure, body composition, and cardiorespiratory fitness were each drawn into the evaluation as well. The study's authors concluded that pairing structured aerobic and resistance training with a reduced-calorie diet proved workable and produced measurable results in people who developed type 2 diabetes at an early age, with the approach showing potential to deliver broad health and well-being gains alongside diabetes remission.

Among the 47 intervention participants whose weight data were included, average body weight dropped from 100.7 kilograms at the outset to 92.3 kilograms by week 24, a reduction of 8.4 kilograms, or roughly 18.5 pounds. Among the 43 control participants, body weight averaged 103.2 kilograms at the outset and edged down to 102.0 kilograms by the end — a reduction of 1.2 kilograms, equivalent to roughly 2.6 pounds.

On a statistically adjusted basis, those enrolled in the combined programme shed an average of 7.5 kilograms — roughly 16.5 pounds — beyond what was observed among people assigned to standard care. Of that gap, roughly 6.6 kilograms — equivalent to around 14.6 pounds — came from body fat alone. Lean body composition, including both muscle tissue and fat-free mass, held steady according to the team's findings.

Among the 50 people who received the intervention, 43 reported at least one unwanted health effect — a rate that stood in stark contrast to the six cases documented among the 46 participants assigned to standard treatment. Constipation, headaches, dizziness, and fatigue were among the early responses tied to the reduced-calorie regimen, and all of them cleared up over time. Throughout the trial period, participants experienced no safety events meeting the threshold for serious harm.

Weight regained after structured eating programmes — among them low-energy diets aimed at pushing type 2 diabetes into remission — represents a pattern the paper's authors drew attention to, noting that partial or full reversal of losses is a common outcome. Restricting food intake alone tends to pull from both fat reserves and lean body mass — muscle tissue among them. Research points to a pattern in which the body, upon regaining weight, tends to rebuild adipose tissue ahead of lean tissue, leaving individuals with a net deficit in fat-free mass and a heightened vulnerability to sarcopenia — a progressive deterioration of muscle volume and physical function — as time passes.

The RESET for Remission study deliberately incorporated resistance training during the intensive weight-loss phase to protect muscle tissue, and the data gathered point to fat-free mass being maintainable even when weight comes off at a rapid pace, the research team reported. Retaining muscle tissue while pursuing weight-loss strategies aimed at remission may carry meaningful consequences for how the body regulates energy over time, how well a person moves and functions day to day, and how the underlying condition progresses.

Those findings were published by the research team in The Lancet Regional Health Americas, with the authors noting that longer-term study would be needed to explore the question further.

The RESET for Remission trial's research team reported that, by directing attention toward people who develop type 2 diabetes at an early age — a patient group already carrying heightened cardiovascular risk, a heavier cumulative burden of complications, and generally poor long-term health trajectories — the study addressed a population whose numbers are growing. The team reported that combining a structured programme of both aerobic and resistance exercise with a low-calorie dietary regimen produced elevated remission rates, reduced body fat while maintaining muscle mass, raised muscle quality and physical function, supported cardiovascular health, and generated measurable gains in outcomes that patients themselves reported.

The worldwide rise in type 2 diabetes among younger populations points toward a broader rethinking of treatment approaches, with combined dietary and exercise programmes showing enough promise, according to the authors, to warrant wider, structured rollout aimed at disease remission. The method under discussion may hold particular utility for individuals who are pregnant, planning to conceive, or considered to have reproductive potential. Longer-term investigation in real-world conditions was identified by the authors as the appropriate next step.