Type 2 Diabetes Remission: Study Finds 54% Success With Intensive Diet and Exercise

An intensive weight loss program helped more than half of a small group of adults with early-onset type 2 diabetes reach remission within six months. The result is striking, but the regimen’s daily calorie limit and reported side effects make its practical reach less clear.

The study, published in The Lancet Regional Health, followed 96 adults ages 18 to 45 at research centers in England and Canada. All had obesity and had received a type 2 diabetes diagnosis within the previous six years. None used insulin to manage the condition.

A 24-week program produced a sharp difference

Researchers assigned participants either to usual diabetes care or to a structured lifestyle program. For the first 12 weeks, the program set daily intake at 800 to 900 calories, divided into 30% protein, 50% carbohydrates, and 20% fat. Participants also attended supervised aerobic and resistance training twice a week and were asked to complete another session independently.

For the next 12 weeks, they moved to a weight maintenance diet and continued exercising on their own. By week 24, 27 of the 50 people in the program group—54%—met the study’s definition of remission. Their A1C, a measure of average blood sugar over roughly two to three months, had fallen below 6.5% and remained there without medication. In the usual care group, two of 46 participants, or 4%, reached that threshold.

The researchers calculated that participants in the program were 21 times more likely to achieve remission than those receiving standard care. They also lost substantially more weight: an average of 18.5 pounds over 24 weeks, compared with 2.6 pounds in the control group.

That contrast makes the result compelling, though the study was small and focused on a specific population: younger adults with obesity and relatively recent type 2 diabetes. The findings don’t establish that the same remission rate would apply to older adults, people with longer-standing diabetes, or those with different health profiles.

Weight loss may explain much of the effect

Lead author Kaberi Dasgupta, M.D., director of general internal medicine at McGill University, points to fat loss as a likely part of the explanation. Some of that fat is lost from the liver, where excess fat can contribute to the development of type 2 diabetes.

Exercise may have helped participants lose fat while preserving muscle. Dasgupta said the combination of aerobic and resistance training likely shaped the kind of weight people lost. Jessica Cording, R.D., C.D.N., author of The Little Book of Game-Changers, adds that retaining or building muscle can support blood sugar management and help people maintain weight loss.

Significant weight loss can lower A1C, Cording said, but the study doesn’t isolate the contribution of diet from exercise or weight loss. The outcomes reflect the full program: a very low calorie intake, frequent exercise, supervision, and a later maintenance phase.

The calorie target came with a high burden

The protocol’s most difficult feature may also be its least transferable. Eating 800 to 900 calories a day is an extreme restriction and generally calls for close medical supervision, Cording said. The study also reported substantial discomfort: 86% of participants in the diet and exercise group experienced significant adverse effects, including constipation, headaches, dizziness, or sensitivity to cold.

David Cutler, M.D., a family medicine physician at Providence Saint John’s Health Center in Santa Monica, California, said the results came at a cost. He also flagged the study’s limited follow-up. Participants were tracked for only six months, so it’s not clear how long remission lasted or how well people could maintain the changes outside the structured research setting.

That question matters because remission depends on keeping blood sugar in range. A short-term drop in A1C doesn’t by itself answer whether someone can sustain the eating and activity habits that helped produce it.

A slower approach may be more workable

Dasgupta said similar results may be possible with a less restrictive diet, though the study didn’t test that approach. Cording expects that reducing calories less sharply could take longer to produce remission, but may also be easier to tolerate and sustain.

Her practical suggestion is a more moderate calorie reduction, with enough protein and fiber to help people feel full. The study’s 24-week timeline shouldn’t be treated as a deadline, she said. People can work toward weight loss at a pace that fits their lives, while planning from the outset for weight maintenance.

The study didn’t include adults over 45. Cording thinks older adults might also benefit, though the timeline or degree of change could differ. That remains a possibility rather than a result demonstrated by this trial.

The clearest takeaway is that substantial weight loss paired with both aerobic and resistance exercise can coincide with type 2 diabetes remission in some people. The 54% figure describes a closely structured program for a narrow group, and the side effects underline why any intensive dietary change needs clinical guidance. For broader use, the more useful question is whether a less restrictive plan can deliver meaningful weight loss and lasting blood sugar improvements at a pace people can maintain.