In an era when the answer to almost every metabolic question seems to arrive in a weekly injection pen, a randomized trial of younger adults with type 2 diabetes offers a different kind of result.
More than half of those assigned to a supervised diet-and-exercise program reached type 2 diabetes remission after 24 weeks. Among participants receiving usual care, the figure was just 4%.
The intervention did not involve a weight-loss medication. It used a tightly controlled low-energy diet, meal replacements, structured aerobic and resistance training, and ongoing medical supervision.
Glucose-lowering medicines were withdrawn under physician oversight, with treatment restarted when clinically necessary. The program was intensive, closely monitored and limited to selected adults with relatively recently diagnosed diabetes.
Published online in The Lancet Regional Health – Americas on October 1, 2026, the RESET for Remission trial was conducted at three centers in the United Kingdom and Canada. Its findings received renewed attention in November.
The result is encouraging. It is also narrower than saying that diet and exercise can replace diabetes medication for everyone.
Why Early-Onset Type 2 Diabetes Is a Different Problem
Type 2 diabetes diagnosed before middle age often follows a more aggressive course than diabetes first identified later in life.
Younger patients can face decades of exposure to elevated blood sugar, increasing their lifetime risk of cardiovascular, kidney and other diabetes-related complications.
That makes remission a particularly important research goal.
In RESET, remission meant an HbA1c level below 6.5%, or 48 mmol/mol, without glucose-lowering medication for at least 12 weeks.
HbA1c reflects average blood glucose over approximately the preceding two to three months. Falling below the diabetes diagnostic threshold without glucose-lowering medication is therefore clinically meaningful.
But remission is not the same as a cure. Blood sugar can return to the diabetes range, especially if weight is regained or the underlying metabolic disease progresses.
Earlier trials, including DiRECT and DIADEM-I, had already demonstrated that substantial dietary weight loss can induce remission in some people with type 2 diabetes.
RESET asked a more specific question: could a combined low-energy diet and supervised exercise program achieve remission in adults aged 18 to 45 with early-onset type 2 diabetes, while also improving body composition, fitness and cardiovascular measurements?
That is an important distinction. The study was not designed to prove that exercise alone reverses diabetes or that lifestyle treatment is superior to medication.
How the RESET for Remission Trial Worked
Researchers randomized 96 adults who had received a type 2 diabetes diagnosis within the previous six years and were living with obesity.
Fifty participants were assigned to the intervention. Forty-six received usual care.
The average participant was 38 years old, and the average body mass index was 35.2.
People receiving insulin or weight-loss medication were excluded, as were people with certain significant cardiovascular, kidney and other medical conditions.
The trial was randomized and open-label, meaning participants knew which program they had been assigned to. Outcome assessment was blinded to reduce potential bias.
The intervention lasted 24 weeks, divided into an intensive weight-loss phase and a maintenance phase.
During the first 12 weeks, participants followed an approximately 800- to 900-kilocalorie-per-day low-energy diet, with additional intake prescribed on exercise days.
For the first two weeks, the program used total meal-replacement products. During the following ten weeks, participants continued the low-energy approach but could include a structured ordinary meal containing foods such as protein, vegetables and fruit.
Glucose-lowering medicines were stopped at program initiation under physician supervision and restarted when clinically indicated. Blood-pressure medications were also reviewed and adjusted under the study protocol, with exceptions for specific medical needs.
From week three, participants attended two supervised exercise sessions each week, combining aerobic training and resistance exercises. They also completed a third aerobic session independently.
The supervised sessions gradually progressed toward approximately one hour each and included activities such as treadmill walking, resistance machines and free weights.
During weeks 13 through 24, participants transitioned toward a weight-maintenance diet and continued physical activity with support from the research team.
Physicians, dietitians and exercise specialists monitored progress, including blood glucose, blood pressure and treatment tolerance.
This was not simply advice to eat less and join a gym. It was a structured medical intervention requiring substantial time, clinical attention and participant effort.
The Result: 27 of 50 Reached Diabetes Remission
At week 24, 27 of the 50 participants assigned to the intensive program were in remission.
That is 54%.
In the usual-care group, only 2 of 46 participants, or approximately 4%, met the same definition.
The absolute difference was 50 percentage points, with a reported 95% confidence interval of 33 to 64 percentage points.
Researchers also reported an adjusted odds ratio of 21.6, although its wide confidence interval reflected uncertainty about the precise magnitude of the effect.
The primary analysis included all randomized participants, counting those with missing endpoint data as not in remission. Overall, 86 of the 96 participants attended their final assessments.
The intervention group’s remission rate was 58% at week 12, falling to 54% by week 24.
Another finding stood out: all 14 intervention participants who lost at least 10% of their starting body weight were in remission by week 24.
That relationship supports the importance of substantial weight loss, but the subgroup was small. It does not mean every patient who loses 10% of body weight will necessarily achieve remission.
On average, the intervention produced approximately 7.5 kilograms greater weight reduction than usual care.
DXA measurements indicated an adjusted between-group reduction in fat mass of approximately 16.5%, while imaging showed favorable changes in fat stored in the liver, pancreas and skeletal muscle.
These tissue measurements are relevant because abnormal fat accumulation in metabolic organs is implicated in the development of insulin resistance and impaired glucose regulation.
The central finding is clear: in this selected group, the combined intervention produced substantially more short-term remission than usual care.
What the study cannot yet establish is how long that remission will last.
The Muscle and Heart Findings May Matter Beyond Blood Sugar
One of RESET’s more interesting secondary findings concerns muscle.
Rapid weight loss can involve reductions in both fat and lean tissue. That concern has become increasingly prominent as obesity-drug developers investigate additional therapies intended to protect muscle during substantial weight reduction.
RESET deliberately included resistance training alongside aerobic exercise and dietary restriction.
At 24 weeks, changes in measured muscle volume and fat-free mass did not differ significantly between the intervention and usual-care groups.
Handgrip strength, however, was approximately 7.6% greater in the intervention group, and researchers observed reductions in fat infiltration within skeletal muscle.
Those are encouraging muscle-related findings during a period of major weight loss.
They do not prove that the exercise component prevented all lean-tissue loss. The trial had no diet-only group, and a nonsignificant difference in fat-free mass is not the same as formally demonstrating equivalence.
The fitness findings require a similar distinction.
Cardiorespiratory fitness expressed relative to body mass improved by approximately 10.3% compared with usual care. Absolute aerobic capacity, however, did not differ significantly between groups.
That matters because losing weight can improve a fitness measurement expressed per kilogram even without a comparable increase in the total amount of oxygen the body can use during exercise.
The intervention also produced favorable blood-pressure results.
Compared with usual care, systolic and diastolic blood pressure were approximately 4 and 5 mmHg lower, respectively, and resting heart rate was around 5 beats per minute lower.
Among participants with hypertension at baseline, 56% of those assigned to the intervention met the trial’s hypertension-remission criteria, compared with 27% receiving usual care.
Cardiac MRI also showed favorable changes in aspects of left ventricular structure. However, the study did not establish statistically significant between-group improvements in measured diastolic function.
Patient-reported outcomes, including depressive symptoms and diabetes-related distress, also showed improvements.
Together, these findings suggest benefits extending beyond a single glucose measurement, although the secondary outcomes require cautious interpretation in a relatively small trial.
The Costs, Side Effects and Limits of Six Months
The program was effective for many participants. It was not easy.
Forty-three of 50 intervention participants reported at least one adverse event, compared with six of 46 participants receiving usual care.
Commonly reported problems included constipation, headache, dizziness and fatigue, particularly during the early low-energy-diet period. Musculoskeletal pain and injuries were also reported.
The researchers reported no serious adverse events.
That distinction is important. The absence of serious events in this small study does not mean the diet or exercise protocol was free from adverse effects, or that similarly restrictive diets are safe without medical supervision.
The participants had regular access to clinical staff, including professionals responsible for medication management and nutritional support.
Attendance at supervised exercise was relatively strong. The median participant completed 17 of 20 planned supervised sessions.
Yet only 40% of the intervention group met the full combined adherence criteria.
That is a reminder of the practical burden involved in following an intensive nutritional and exercise program while managing the demands of work, family and ordinary life.
The trial also leaves important scientific questions unanswered.
There was no diet-only comparison group. The researchers therefore cannot separate the additional effect of supervised exercise from the effects of dietary weight loss and the other components of the program.
Participants receiving the intervention also had more contact with healthcare professionals than those receiving usual care, which may have influenced adherence and other outcomes.
The study enrolled only 96 selected adults, excluding several groups commonly encountered in diabetes practice.
Most importantly, follow-up ended at 24 weeks.
Earlier dietary-remission research has found that weight regain and recurrence of diabetes-range glucose levels can become substantial challenges over time.
RESET cannot tell us how many of the 27 intervention participants will remain in remission after one, three or five years.
Six months of remission is a strong start. Diabetes is measured in decades.
What This Means Alongside GLP-1 Drugs
It would be a mistake to frame RESET as proof that diet and exercise are better than medication.
The trial compared a combined lifestyle intervention with usual care. It did not directly compare the program against semaglutide, tirzepatide or any other modern glucose-lowering or obesity medicine.
GLP-1-based treatments have substantial evidence for blood-glucose control and weight reduction, and many people with type 2 diabetes require ongoing medication to manage the disease and reduce complications.
Newer investigational therapies are also producing large metabolic effects in clinical trials. We examined one such head-to-head comparison in our report on retatrutide versus Ozempic in type 2 diabetes.
But a treatment that lowers HbA1c while a person is taking a medication is not being assessed against the same endpoint as remission after at least 12 weeks without glucose-lowering drugs.
That is one reason direct comparisons between drug trials and diet-remission trials can mislead.
Metformin itself remains an important part of type 2 diabetes care, even as researchers continue examining its effects on metabolism and appetite. We recently covered new research on metformin’s Lac-Phe signaling pathway.
RESET offers a different possibility for a specific population: selected younger adults with early type 2 diabetes and obesity may be able to achieve medication-free remission through a carefully supervised, time-limited intervention.
That option comes with costs of its own, including intensive nutritional management, scheduled exercise, clinician time and sustained behavioral effort.
The researchers identified potential relevance for younger adults considering pregnancy, but the study itself did not test pregnancy outcomes or determine the best treatment for people planning conception.
Ultimately, the most useful question is not whether diet should defeat drugs or drugs should defeat diet. It is which combinations of treatment, support and sustained behavior produce the safest and most durable outcomes for different patients.
RESET makes a meaningful contribution to that question.
In a randomized trial, more than half of younger adults assigned to a structured diet-and-exercise program reached type 2 diabetes remission at 24 weeks. Weight, fat distribution, strength and several cardiovascular measures also improved.
The next test is whether the remission lasts, whether the program can work outside research centers, and how much benefit supervised exercise adds to intensive dietary treatment on its own.
RESET shows that medication-free remission is achievable for some younger adults. It does not show that diabetes has disappeared for good.
Clinical context: The dietary restriction and medication adjustments described here were conducted under medical supervision. People taking diabetes medication should not stop treatment or attempt a comparable low-energy diet without assessment and monitoring by their healthcare team.
Sources
Primary clinical trial: Dasgupta K, Boulé NG, Henson J, et al. 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. Published online October 1, 2026. Article 101664. DOI: 10.1016/j.lana.2026.101664.
Research institution: University of Leicester — Study Shows Low Energy Diet Combined With Structured Exercise Reverses Early-Onset Type 2 Diabetes in Half of Participants. October 9, 2026.
Clinical study protocol: Dasgupta K, Yates T, et al. Remission of Type 2 Diabetes and Improved Diastolic Function by Combining Structured Exercise With Meal Replacement and Food Reintroduction Among Young Adults: The RESET for REMISSION Randomised Controlled Trial Protocol. BMJ Open. September 2022.
Additional study reporting: News-Medical — A Low-Calorie Diet and Exercise Helped 54% of Younger Adults Achieve Diabetes Remission. November 3, 2026.
Remission definition: Riddle MC, Cefalu WT, Evans PH, et al. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care / Journal of Clinical Endocrinology & Metabolism. 2021.
Dietary clinical guidance: National Institute for Health and Care Excellence — Overweight and Obesity Management: Physical Activity and Diet. Guidance concerning low-energy dietary interventions and clinical supervision.
