Low Energy Diet Plus Supervised Exercise Tied to Early-Onset Type 2 Diabetes Remission: Lancet
Canada: A low-calorie diet paired with exercise successfully reversed early-onset type 2 diabetes in 54% of young adult participants after 24 weeks without medication, compared to just a 4% remission rate in the standard care group.
The findings come from the RESET for Remission randomised trial published in The Lancet Regional Health – Americas by Kaberi Dasgupta, Department of Medicine, McGill University, Montreal, Canada, and colleagues. The study evaluated whether combining a low-energy diet (LED) with structured exercise could achieve diabetes remission in adults with early-onset type 2 diabetes (EOT2D), a group at increased risk of developing complications over their lifetime.
The open-label, blinded-endpoint trial included adults aged 18–45 years with type 2 diabetes, obesity and no insulin therapy. A total of 96 participants were randomised across three centres in England and Canada between September 2021 and June 2025.
Participants assigned to the intervention initially followed an 800–900 kcal/day low-energy diet for 12 weeks alongside twice-weekly supervised aerobic and resistance exercise and one independently performed exercise session each week. During weeks 13–24, they transitioned to a weight-maintenance diet and continued independent exercise. The control group received usual care.
Diabetes remission was defined as an HbA1c below 6.5% (48 mmol/mol) without glucose-lowering medication for at least 12 weeks.
Key findings:
- Remission at 24 weeks was achieved by 27 of 50 participants (54%) receiving the combined intervention, compared with 2 of 46 participants (4%) receiving usual care.
- The absolute difference in remission between groups was 50 percentage points, with an adjusted odds ratio of 21.6 (95% CI, 6.2–114.5).
- The intervention was associated with substantial fat loss while preserving fat-free mass and muscle volume.
- Participants also demonstrated greater handgrip strength and improved cardiorespiratory fitness relative to body mass.
- Remission was achieved in 58% of intervention participants after the initial 12-week low-energy diet and supervised exercise phase and remained 54% after the subsequent 12-week maintenance phase.
- Of the 96 randomised participants, 86 (90%) completed the final assessment.
- No serious adverse events were reported. However, 43 participants in the intervention group experienced at least one adverse event, compared with six in the control group, with constipation, headache, dizziness and fatigue commonly occurring during the early low-energy diet phase and generally resolving.
The researchers found that the intervention improved remission while promoting fat loss, preserving muscle mass, and enhancing strength, fitness and patient-reported outcomes.
The study had several limitations, including the absence of a low-energy diet-only group, making it difficult to determine the independent effect of supervised exercise. Unequal researcher contact, imprecise assessment of exercise and dietary adherence, and the selected population may limit generalisability. The six-month follow-up also leaves the long-term durability of remission uncertain.
Overall, combining a low-energy diet with structured aerobic and resistance exercise achieved substantial remission in early-onset type 2 diabetes while improving body composition and fitness. Longer-term studies are needed to assess sustained remission and the added benefit of supervised exercise.
Reference:
Dasgupta, K., Boulé, N. G., Henson, J., Redman, E., Chan, D., McCarthy, M., Rosa, D., Arsenyadis, F., Chevalier, S., Rees, J. L., Lim, J., Rowlands, A., Hadjiconstantinou, M., Da Costa, D., Gregg, E. W., Cowley, A., Friedrich, M. G., Prado, C. M., Sherman, M., . . . Pasqua, M. (2026). Low energy diet plus supervised exercise vs. Usual care alone in people with early-onset type 2 diabetes (RESET for Remission): A randomised, open-label, blinded-endpoint efficacy trial. The Lancet Regional Health - Americas, 101664. https://doi.org/10.1016/j.lana.2026.101664
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