Intensive diet‑exercise program makes young diabetics 21 times more likely to remit

Trial design, participants and sites

The study was open‑label, but the primary outcome of remission was assessed by investigators blinded to group allocation.

The trial compared a combined low‑calorie diet (800–900 kcal daily, 30% protein, 50% carbohydrate, 20% fat) and supervised aerobic and resistance exercise twice weekly for the first 12 weeks, followed by a weight‑maintenance diet and independent exercise for weeks 13 to 24.

The study was conducted at fewer than 100 individuals across the three centres over a six‑month period, as reported by media outlets covering the trial.

Low‑calorie diet and supervised training protocol

Participants followed a diet of 800 to 900 calories daily. For the first two weeks, they consumed only meal-replacement products. These products consisted of Optifast in the UK and ProtiDiet in Canada.

This meal met targets of 60 to 90 grams of protein, one portion of fruit, and two portions of non-starchy vegetables. Participants drank at least two litres of calorie-free fluids daily.

They also had access to a fibre-based laxative when needed. The final twelve weeks involved a weight-maintenance phase.

Resistance training was used to preserve muscle mass while the diet drove weight loss. The results suggest that substantial fat loss can be achieved while preserving muscle.

MRI scans indicated that muscle mass did not decrease during the study. Handgrip strength increased among the participants. Cardiovascular fitness and treadmill endurance also showed significant improvements.

Weight loss and metabolic outcomes

After 24 weeks, 27 of 50 participants in the intensive programme achieved diabetes remission. Only two of the 46 participants in the standard-care group achieved this result.

Control participants lost 1.2 kg, moving from 103.2 kg to 102.0 kg.

The analysis used an intention-to-treat approach, counting participants with missing data as non-remitters. Researchers also examined changes in body composition, cardiovascular fitness, and heart structure.

This was permitted in the absence of albuminuria.

The intervention lowered blood sugar and reduced body fat. It also improved muscle quality, physical performance, and reported well-being. Weight loss was substantially greater among those in the combined diet and exercise programme.

Safety profile and side effects

The trial reported no severe adverse events among participants, indicating a mild safety profile for the intensive programme.

Adverse events occurred in 43 of the 50 participants receiving the low‑calorie diet and exercise, compared with six of the 46 receiving standard care, and early‑stage symptoms included constipation, headache, dizziness and fatigue, which generally resolved.

Researchers noted that the study’s small size of fewer than 100 participants, its six‑month duration, and the inability to isolate the separate effects of diet versus exercise limit the conclusions that can be drawn.

Researchers’ commentary on findings

Dr. Kaberi Dasgupta said, "Our study shows that it is possible to combine a low‑calorie diet with supervised exercise in young adults with type 2 diabetes".

They stated, "Our remission rates are at the upper end of those previously reported in the literature for trials of similar duration, reinforcing the potential of structured lifestyle interventions to support clinically meaningful remission, while demonstrating for the first time that such effects can be achieved in a multi‑ethnic population with early‑onset type 2 diabetes through a combined low‑energy diet and structured exercise intervention".

Background information notes that early‑onset type 2 diabetes, diagnosed under age 45, is particularly aggressive, with faster decline in blood‑sugar control, earlier development of complications and a shorter life expectancy than diabetes diagnosed later in life.

Implications for young adults and future research

The authors acknowledged that longer‑term studies are needed to assess muscle preservation, sustained remission and broader health impacts, marking the next step for research in this area.