A new clinical trial demonstrates that a strict low-calorie diet combined with supervised exercise can reverse type 2 diabetes in over half of young adults with early-onset disease. The RESET for Remission study found that 54% of participants achieved remission after 24 weeks—defined as maintaining an HbA1c below 6.5% without glucose-lowering medication—compared to just 4% in the standard care group.
Researchers required participants to follow an 800-900-calorie daily meal-replacement diet alongside structured exercise, including twice-weekly supervised aerobic and resistance training plus one independent session per week. After 12 weeks, participants transitioned to a nutritionally optimized maintenance phase with reduced meal replacements and continued independent exercise. The findings were presented at the European Association for the Study of Diabetes meeting in Milan by Kaberi Dasgupta, MD, of McGill University, and published simultaneously in Lancet Regional Health Americas.
Remission rates remained consistent across subgroups by sex, ethnicity, and study country. Dasgupta noted the study’s challenges: “It’s already difficult for someone to adhere to a meal-replacement diet. Adding supervised exercise makes it even harder. But when they succeed, they gain the combined benefits of weight loss, remission, and metabolic advantages from exercise.” 90% of participants completed the final assessment, indicating strong adherence despite the demanding protocol. Non-completers were assumed not to have achieved remission. The trial included 96 adults aged 18 to 45 (average age 38) diagnosed within the prior six years, with a baseline HbA1c between 6.5% and 10.0% (mean 7.2%). At enrollment, 74% were taking metformin, 20% an SGLT2 inhibitor, and a small group a GLP-1 drug.
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The study focused on early-onset type 2 diabetes, defined as diagnosis before age 45, a condition linked to rapid glucose deterioration and higher risks of complications such as fertility challenges, job instability, or relationship stress. Dasgupta emphasized the impact: “These complications can disrupt lives when people are just starting theirs. The effects are real and cause significant suffering.” Compared to anti-obesity drugs like tirzepatide (Mounjaro), which produced 28.4 lbs of weight loss over 52 weeks in the SURPASS-3 trial, the RESET intervention resulted in 16.5 lbs lost at 24 weeks. However, it delivered greater reductions in visceral and liver fat, according to Thomas Yates, PhD, of the University of Leicester.
“Visceral and liver fat drive metabolic benefits, and this approach targets those specifically.” Whole-body MRI scans confirmed improvements across multiple fat deposits, including pancreatic fat, abdominal subcutaneous fat, thigh intermuscular fat, and intramuscular fat. Intervention participants also saw greater gains in handgrip strength, reduced depression symptoms, lower diabetes distress, improved quality of life, and better blood pressure, with 56% achieving hypertension remission versus 27% in the control group.
No serious adverse events occurred. Common side effects included headaches, constipation, dizziness, and fatigue during diet initiation, along with a slightly higher rate of mild infections in the intervention group. Yates cautioned that while the results are promising, the study’s two-arm design means further research is needed to isolate exercise’s added benefit. The findings suggest a potential new pathway for managing early-onset type 2 diabetes through structured lifestyle interventions.
