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Can Diet and Exercise Reverse Type 2 Diabetes?

In a 96-person randomized trial, a low-energy diet plus supervised exercise put early type 2 diabetes into remission in 54% versus 4% on usual care.

A 12-week low-energy diet plus supervised exercise achieved remission at 24 weeks in 54% in the intervention group.

In a 96-person randomized trial, adults aged 18–45 with early-onset type 2 diabetes who followed a 12-week low-energy meal-replacement diet plus supervised exercise went into diabetes remission at 24 weeks in 54% of cases, against 4% given usual care. Because the trial compared only two groups — diet plus exercise versus usual care — it cannot show how much of that effect the exercise added to the diet.

What this means

In a 96-person randomized trial, a 12-week low-energy meal-replacement diet plus supervised exercise, followed by weight maintenance, put early-onset type 2 diabetes into remission in 54% of participants, against 4% given usual care. The gap is large, but the trial had only two arms — diet plus exercise versus usual care — so it cannot show how much the exercise added beyond the diet. The adjusted odds ratio was 21.6 (95% CI 6.2 to 114.5); that wide interval measures how imprecise the estimate is. The findings apply to adults aged 18–45 with recent-onset diabetes and obesity who were not on insulin, not to older or longer-duration patients.

The trial and its question

The RESET for Remission trial randomized 96 adults aged 18 to 45 whose type 2 diabetes had been diagnosed before age 45 and within about the previous six years. Participants had obesity (mean BMI 35.2) and were not using insulin. Half were assigned to the combined program and half to usual care at three centers in England and Canada. The 12-week intensive phase paired an 800–900 kcal/day meal-replacement diet with twice-weekly supervised aerobic and resistance exercise plus one weekly independent session; a 12-week weight-maintenance phase followed.

The primary result

Remission was the prespecified primary outcome: an HbA1c below 6.5% at 24 weeks without glucose-lowering medication for at least 12 weeks. It was reached by 27 of 50 participants in the intervention arm (54%) and 2 of 46 in the usual-care arm (4%) — an absolute difference of 50 percentage points (95% CI 33 to 64). The adjusted odds ratio was 21.6 (95% CI 6.2 to 114.5). Analysts counted everyone as randomized, assuming the 10 participants who missed final assessments had not gone into remission.

A landmark, and a question left open

RESET follows the DiRECT trial, which showed a primary-care low-energy diet could induce remission in about 46% of participants at 12 months. DiRECT did not measure heart function, but a related Leicester trial (DIASTOLIC) found that a low-energy meal-replacement diet alone did not improve diastolic heart function, while supervised exercise did — the gap RESET was built to address. Only the abstract was available to us at press time, so RESET’s registered cardiac result could not be read, and no companion paper reporting it was located.

What the two-arm design cannot show

The trial compared diet plus exercise against usual care, not exercise against diet, so it cannot isolate what the exercise added to the diet; the investigators say so explicitly. It was also open-label — participants and clinicians knew their group, although outcomes were adjudicated blind — and recruitment took about four years (2021–2025).

What this does not cover

These findings do not extend to adults over 45, to longer-duration diabetes, to people on insulin, or to people without obesity. Most intervention participants (43 of 50, versus 6 of 46 on usual care) had at least one adverse event, mainly early diet effects — constipation, headache, dizziness, fatigue — that resolved. No serious adverse events were reported in either arm. Nothing here is advice to stop or change medication. Nutritious News covered a different dietary question — whether a shorter daily eating window improves metabolic health — in does-time-restricted-eating-work.

Terms explained

  • Type 2 diabetes remission — blood sugar returning to the nondiabetic range and staying there without glucose-lowering medication.
  • HbA1c — a blood test reflecting average blood sugar over roughly the previous two to three months; 6.5% is the usual threshold for diagnosing diabetes.
  • Low-energy diet (meal replacement) — a very low-calorie phase, here 800–900 kcal a day, in which shakes and soups replace ordinary meals, followed by a return to normal food.
  • Early-onset type 2 diabetes — diabetes diagnosed before age 45; this trial enrolled adults up to 45 whose diagnosis came within about six years.
  • Adjusted odds ratio — a ratio comparing the odds of an outcome in one group with the odds in the other, adjusted for other factors. Here it was 21.6, with a 95% confidence interval of 6.2 to 114.5.

Sources

  1. Primary source: Dasgupta K, Boulé NG, Henson J, Redman E, 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 2026, published 2026-10-01. https://doi.org/10.1016/j.lana.2026.101664 (doi:10.1016/j.lana.2026.101664; no PMID assigned). Registration: ISRCTN15487120. Only the abstract was accessible to us at press time; the full text was not. Funding: UK Medical Research Council (MR/T031816/1), Canadian Institutes of Health Research (UCD-170584), John R. McConnell Foundation; co-author disclosures via MedPage Today — one co-investigator (Yates) reports relationships with Biomea Fusion, Abbott, and Regeneron.
  2. Trial protocol and registration record: Dasgupta K, Boulé NG, Henson J, Redman E, 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 2022;12(9):e063888. https://doi.org/10.1136/bmjopen-2022-063888 (doi:10.1136/bmjopen-2022-063888; PMID: 36130753). Full text read; confirms the prespecified primary outcome and that peak early diastolic strain rate was a key secondary outcome.
  3. Landmark prior trial (context): Lean MEJ, Leslie WS, Barnes AC, et al. “Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial.” The Lancet 2018;391(10120):541-551. https://doi.org/10.1016/S0140-6736(17)33102-1 (doi:10.1016/S0140-6736(17)33102-1; PMID: 29221645). Abstract-level access.
  4. Discovery signal (secondary; not used for any verified number): “Low-Calorie Diet, Exercise Reversed Type 2 Diabetes Without Meds.” MedPage Today, EASD 2026 coverage, event-dated 2026-10-05. https://www.medpagetoday.com/meetingcoverage/easd/123280

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