More than half of young adults with early-onset type 2 diabetes who followed an intensive six-month program of a very low-calorie diet and supervised exercise went into remission, according to a clinical trial published this week, a result researchers say was far beyond what standard care achieved over the same period.
The trial, called RESET for Remission and published in The Lancet Regional Health – Americas, enrolled 96 adults aged 18 to 45 with obesity and early-onset type 2 diabetes at sites in Leicester, England, Montreal and Edmonton. It was led by Professor Kaberi Dasgupta of McGill University and Professor Thomas Yates of the University of Leicester.
Half the participants were randomly assigned to an intensive program: two weeks of total meal replacement at 800 to 900 calories a day, followed by ten weeks at the same calorie limit with one conventional meal allowed, then a maintenance phase, all paired with supervised aerobic and resistance training twice a week. The other 46 received usual diabetes care. Glucose-lowering medication was stopped at the outset for the intervention group.
21 times more likely to reverse the disease
At 24 weeks, 27 of the 50 participants in the intensive group, 54%, met the trial's definition of remission: blood sugar below the diabetic threshold without medication for at least 12 weeks. In the usual-care group, just two of 46 participants, or about 4%, did. Statistically, the researchers found, the intervention group was roughly 21 times more likely to achieve remission. The diet-and-exercise group also lost an average of 8.4 kilograms, more than six times the 1.2 kilograms lost by the comparison group, with more of that weight coming off as fat rather than muscle.
The authors said the exercise component appeared to matter as much as the diet.
Our RESET for Remission study targeted muscle during the intensive weight loss phase through resistance training.
RESET for Remission study authors
They added that preserving fat-free mass and muscle during rapid weight loss "is achievable" with the right program design, a point they said matters for a group of patients who will otherwise live with diabetes and its complications for decades.
Side effects, mostly constipation, headaches, dizziness and fatigue, were more common in the intensive group but resolved early and were not severe, according to the trial results.
The researchers caution that remission is not a cure, and that people who lose significant weight through dietary programs often regain some of it over time; the trial did not track participants long enough to know whether the gains hold up once supervision ends. The design was also open-label — participants and researchers knew who was assigned to which group, although the remission assessment itself was blinded — and the sample, at 96 people, was small. The authors say the approach warrants further evaluation in longer-term studies in real-world settings.
