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In the randomized RESET for Remission trial, 54% of young adults assigned to a low-calorie meal-replacement diet and structured exercise met the study’s definition of type 2 diabetes remission at 24 weeks, compared with 4% receiving usual care. The small trial reported no serious adverse events, but researchers said further work is needed to establish the added effect of exercise and how durable remission is.
A low-calorie meal-replacement diet paired with structured exercise was followed by remission of early-onset type 2 diabetes in 54% of participants in a 96-person randomized trial, compared with 4% assigned to usual care, according to results presented at the European Association for the Study of Diabetes meeting and published in Lancet Regional Health Americas. Remission meant HbA1c below 6.5% without glucose-lowering medication for at least 12 weeks; the finding applies to this selected trial group and does not establish a permanent reversal of diabetes.
The open-label RESET for Remission trial randomized 96 adults equally to the lifestyle intervention or routine clinical care. Participants were 18 to 45 years old, had received a type 2 diabetes diagnosis within the prior six years, and had a baseline HbA1c from 6.5%—or 6.0% for those taking medication—to 10%. Average age was 38 and mean baseline HbA1c was 7.2%. At the start, 74% were taking metformin, 20% an SGLT2 inhibitor, and a small minority a GLP-1 drug.
For the first 12 weeks, the intervention prescribed 800 to 900 calories a day through meal replacements, twice-weekly supervised aerobic and resistance exercise, and one additional independent exercise session each week. A 12-week maintenance phase followed, with a nutritionally optimized diet, gradual reduction of meal replacements, and independent exercise. At week 24, remission was reported in 54% of the intervention group and 4% of the usual-care group. The adjusted odds ratio was 21.6, with a 95% confidence interval of 6.2 to 114.5.
Ninety percent completed the final assessment. The study counted participants who did not complete it as not having achieved remission. Researchers reported improvements in several additional measures in the intervention group, including blood pressure, triglycerides, handgrip strength, diabetes distress, depression symptoms, and quality of life. No serious adverse events were reported. Temporary symptoms during diet initiation included headache, constipation, dizziness, and fatigue; mild infections were slightly more common in the intervention arm.
What Remission Could Mean for Younger Adults
Early-onset type 2 diabetes can expose people to elevated blood sugar and related risks during years when they may be starting families, relationships, or careers. Trial investigator Kaberi Dasgupta of McGill University said complications at that stage can bring substantial disruption and suffering. The results suggest a structured lifestyle program may help some younger adults reach a period without glucose-lowering medication, a meaningful outcome for patients and clinicians considering options alongside ongoing medical care.
The intervention also showed changes beyond body weight. Study co-investigator Thomas Yates of the University of Leicester said that exercise-related benefits should be assessed using measures beyond total weight. MRI scans showed changes in pancreatic, abdominal, and thigh fat measures, while participants also had greater improvements in handgrip strength and some measures of cardiovascular health than controls. These are trial findings, not proof that the program prevents long-term complications.
The results do not show that participants can safely stop prescribed medication on their own, or that remission will last after the study period. The intervention required intensive dietary restrictions and frequent exercise sessions. Whether it can be offered and sustained at scale will depend on participant support, access, cost, and longer-term outcomes that this trial did not establish.
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How the 24-Week Program Was Structured
Earlier research has found that low-energy meal-replacement diets can support type 2 diabetes remission without surgery. The RESET trial addressed a more specific question: whether a program combining a low-energy diet with structured, supervised exercise could produce remission among people diagnosed before age 45. Its two-arm design compared the combined program with usual clinical care, so the results cannot separate the contribution of diet from the contribution of exercise.
Dasgupta described adherence as a concern because following a meal-replacement diet is already demanding. “It’s already quite a lot to ask someone to adhere to a meal-replacement diet,” she said, adding that supervised exercise makes it more challenging. She said the completion rate suggested many participants liked the exercise and remained in the study. That experience comes from the trial participants and does not show that people in other settings will find the program equally manageable.
Yates compared the results with weight-loss figures reported for tirzepatide in the separate SURPASS-3 trial: RESET participants lost an average of 16.5 pounds at 24 weeks, while the comparator reported 28.4 pounds at 52 weeks. Those figures come from different studies and time periods, so they are not a direct head-to-head comparison. Yates also cited differences in visceral and liver fat measures, but the RESET study was not designed to establish that its intervention is superior to medication.
““It’s already quite a lot to ask someone to adhere to a meal-replacement diet. Adding supervised exercise makes it even more challenging.””
— Kaberi Dasgupta, MD, MSc, McGill University
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Durability and Exercise’s Added Effect
The trial reported remission at 24 weeks; it does not establish whether remission persists over years, whether participants later need medication again, or how the program affects diabetes complications over time. Because the study had only two groups—combined diet and exercise versus usual care—it cannot isolate the added benefit of exercise from the effect of the diet. Researchers said further research is needed to answer that question.
The sample included 96 people who met specific age, diagnosis-duration, and HbA1c criteria. It is not yet clear how well the findings apply to older adults, people with longer-standing diabetes, or those with different health needs. The trial reported no serious adverse events, but its size and duration do not settle the safety or practicality of the program for broader or longer-term use.
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Longer Follow-Up and Larger Trials
Further studies will need to follow participants for longer to measure whether remission lasts, track medication use and diabetes complications, and assess how feasible the intensive program is outside a trial. Researchers also need study designs that can distinguish the effects of the low-calorie diet from those of supervised exercise. Until those results are available, the 24-week findings describe remission in this trial group, rather than a guaranteed or permanent outcome for people with type 2 diabetes.
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Key Questions
What did the trial mean by diabetes remission?
It defined remission as HbA1c below 6.5% without glucose-lowering medication for at least 12 weeks. That definition describes a measured period without medication; it does not establish a permanent cure.
How many participants reached remission?
At 24 weeks, 54% of the intervention group met the remission definition, compared with 4% assigned to usual care. The trial randomized 96 participants in total.
What did participants do in the intervention?
For 12 weeks, they followed an 800-to-900-calorie meal-replacement diet, attended supervised aerobic and resistance exercise twice a week, and exercised independently once a week. A 12-week maintenance phase followed.
Does this show that exercise caused the remission?
No. The trial compared the combined diet-and-exercise program with usual care. It did not have a diet-only group, and the investigators said further research is needed to confirm exercise’s added benefit.
Were serious adverse events reported?
No serious adverse events were reported in the trial. Some participants had temporary headaches, constipation, dizziness, or fatigue during diet initiation, and mild infections were slightly more common in the intervention group.
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