More than half of young adults put type 2 diabetes into remission with diet and exercise, trial finds

More than half of young adults with type 2 diabetes pushed the disease into remission within six months on a structured diet and exercise programme, according to a new clinical trial — without using any new drug.

The trial, called RESET for Remission, found that 54 per cent of adults under 45 who followed a low-calorie diet combined with supervised exercise saw their blood sugar return to the healthy range, with no diabetes medication, after 24 weeks. In the group that received usual care alone, only 4 per cent reached remission.

The results were presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Milan on 30 September 2026, and published simultaneously in the journal The Lancet Regional Health – Americas on 1 October 2026.

The findings are especially relevant in Pakistan, where type 2 diabetes is increasingly affecting younger adults. The International Diabetes Federation’s Diabetes Atlas 2025 estimates that about 34.5 million Pakistani adults have diabetes, and that the country’s age-standardised prevalence of 31.4 per cent is the highest in the world.

At a glance

What happened: In the RESET for Remission trial, 96 adults aged 18 to 45 with early-onset type 2 diabetes and obesity were randomly assigned to either usual care or a structured programme of a low-calorie diet (800–900 calories a day) plus supervised exercise. After 24 weeks, 54 per cent of the diet-and-exercise group were in remission, compared with 4 per cent of the usual-care group.

Why it matters: Type 2 diabetes diagnosed before age 45 is more aggressive than diabetes diagnosed later in life, progresses faster, and cuts life expectancy more. It is also becoming more common in young people. The trial shows that intensive lifestyle change can reverse the disease in a majority of young adults — at least in the short term — and it is the first trial to combine a low-calorie diet with structured exercise in this age group.

What happens next: The trial lasted only 24 weeks, so it does not show whether remission lasts for years. Longer follow-up studies are needed, and researchers say remission programmes need medical supervision — very low-calorie diets are not safe to attempt without a doctor’s guidance. The results are likely to influence how doctors treat early-onset type 2 diabetes, and they strengthen the case for structured diet-and-exercise programmes as a first option for younger adults.

What the trial did

The trial was run at three centres in Canada and the United Kingdom, led by Professor Kaberi Dasgupta of McGill University in Montreal and Professor Thomas Yates of the University of Leicester. It enrolled 96 adults aged 18 to 45 who had obesity and early-onset type 2 diabetes — meaning diabetes diagnosed before the age of 45. None of the participants had yet started insulin therapy.

About half of the participants were assigned to usual care for their diabetes. The other half received a structured programme:

• A low-energy diet of 800 to 900 calories a day for the first 12 weeks, made up of 30 per cent protein, 50 per cent carbohydrate and 20 per cent fat. For the first two weeks, all meals were replaced with formulated shakes and meal replacements. From week three, participants could eat one normal meal a day while staying within the calorie limit.
• Supervised exercise twice a week for 12 weeks, combining aerobic exercise (such as brisk walking or cycling) with muscle-building resistance exercise, plus one independent exercise session a week.
• A weight-maintenance phase for weeks 13 to 24, with a weight-maintenance diet and independent exercise.

The main outcome was remission at 24 weeks. Remission was defined strictly: blood sugar in the healthy range — an HbA1c below 6.5 per cent, the standard blood test for average blood sugar over about three months — and no glucose-lowering medication for at least 12 weeks.

The results

At the 24-week mark, 27 of the 50 people in the diet-and-exercise group — 54 per cent — were in remission. In the usual-care group, only 2 of the 46 people — about 4 per cent — were in remission. After adjusting for other factors, people in the programme were 21 times more likely to reach remission than those on usual care.

The researchers described the result as sitting at the upper end of remission rates reported for trials of comparable length. It is also the first trial to test a low-calorie diet combined with structured exercise in a multi-ethnic group of younger adults with early-onset diabetes.

The diet-and-exercise group also lost significantly more weight: an average of 8.4 kilograms over 24 weeks, from an average starting weight of 100.7 kilograms, compared with 1.2 kilograms in the usual-care group. Of the weight lost in the intervention group, about 6.6 kilograms was fat, while muscle mass was largely preserved — an important detail, because muscle loss is a common problem with very low-calorie diets, and the resistance exercise was designed to prevent it.

The researchers also reported improvements in muscle quality and function, cardiovascular health and patient-reported outcomes — how participants felt about their health and daily life.

Why early-onset diabetes is different

Type 2 diabetes used to be a disease of middle-aged and older adults. That is changing. It is now appearing in more people under 40 and under 45, in Pakistan and around the world, driven by rising obesity, less physical activity and changes in diet.

Diabetes that starts young is not simply the same disease arriving earlier. It tends to be more aggressive: blood sugar rises faster, complications such as eye, kidney and nerve damage arrive earlier in life, and life expectancy is reduced more than when diabetes is diagnosed later. That is why researchers say early-onset diabetes deserves a strong intervention, early — to slow or reverse its rapid course.

Until now, most of the evidence for diabetes remission came from older adults. The best-known study, the DiRECT trial published in The Lancet in 2018, found that nearly half of UK adults who followed a low-calorie diet in primary care were in remission after a year. But DiRECT did not include a structured exercise programme, and it did not focus on younger adults. The RESET trial fills both gaps.

“In early-onset type 2 diabetes, combining structured aerobic and resistance exercise with a low-calorie diet produces high remission rates, induces fat loss while preserving muscle mass, improves muscle quality and function, enhances cardiovascular health, and leads to meaningful improvements in patient-reported outcomes,” the research team, co-led by Dr Dasgupta, concluded.

Remission is not a cure

It is important to understand what remission means — and what it does not mean.

Remission means blood sugar has returned to the healthy range without medication. It does not mean the disease is cured. The underlying tendency towards diabetes remains, and blood sugar can rise again if weight comes back or healthy habits slip. That is why doctors describe remission as something to maintain, not a finish line.

The trial also had limits that matter. It was small — only 96 people — and it lasted only six months. It was open-label, meaning participants knew which group they were in, although the main outcome was assessed by researchers who did not know the group assignments. The diet was demanding: 800 to 900 calories a day is very low, and the first two weeks involved total meal replacement. That is not something anyone should attempt on their own.

Very low-calorie diets must be medically supervised. They are not suitable for everyone — they are not appropriate for people on insulin, for example, and they can cause side effects including gallstones, constipation, hair loss and, in rare cases, more serious problems. Anyone considering a weight-loss plan for diabetes should discuss it with a doctor first.

The trial also took place in Canada and the UK, with structured support, supervised exercise sessions and formulated meal replacements. Whether the same results can be achieved in other settings — including Pakistan, where such programmes are not widely available — is an open question.

What this means for Pakistan

Pakistan faces one of the world’s heaviest diabetes burdens. According to the IDF Diabetes Atlas 2025, about 34.5 million adults aged 20 to 79 are living with diabetes, the fourth-highest total in the world. The age-standardised prevalence of 31.4 per cent is the highest in the world — nearly one adult in three.

About 26.9 per cent of people with diabetes in Pakistan — roughly 9.3 million people — do not know they have the disease. And the number of cases is projected to reach 70.2 million by 2050 if preventive measures are not taken.

The RESET results suggest that, for younger adults who are diagnosed early, structured diet and exercise could be a powerful first step — before, or alongside, medication. But a programme like the one in the trial needs dietitians, supervised exercise and medical monitoring. In Pakistan, where many people with diabetes receive little structured support, building that kind of care is a challenge.

There are also simpler lessons that do not need a trial programme. Regular physical activity, a diet lower in sugary drinks and refined carbohydrates, and maintaining a healthy weight are the foundations of diabetes prevention and control — and they are within reach for many people, even without a formal programme. Walking briskly for 30 minutes a day, for example, is a realistic starting point that doctors commonly recommend.

The results also arrive at a moment of rapid change in diabetes treatment. New medicines, including the GLP-1 drugs such as Ozempic and the experimental “triple-G” drug retatrutide, are producing large weight losses. But drugs are expensive and not always available. A diet-and-exercise programme that achieves remission without drugs is a different kind of answer — one that depends on support and willpower rather than a prescription.

Frequently asked questions

What is diabetes remission?

Remission means blood sugar has returned to the healthy range — an HbA1c below 6.5 per cent — without taking any glucose-lowering medication for at least 12 weeks. It is not a cure: blood sugar can rise again if weight returns.

What did the RESET trial find?

In 96 adults aged 18 to 45 with early-onset type 2 diabetes and obesity, 54 per cent of those on a structured low-calorie diet and supervised exercise programme were in remission after 24 weeks, compared with 4 per cent of those receiving usual care. The diet-and-exercise group lost an average of 8.4 kg, compared with 1.2 kg in the usual-care group.

What did the programme involve?

A diet of 800 to 900 calories a day for 12 weeks, followed by a weight-maintenance diet; supervised aerobic and resistance exercise twice a week, plus one independent session a week. The programme was medically supervised and is not something to attempt without a doctor’s guidance.

Can I try an 800-calorie diet on my own?

No. Very low-calorie diets must be medically supervised and are not suitable for everyone. They can cause side effects and are not appropriate for people on insulin or with certain health conditions. Anyone considering a weight-loss plan for diabetes should speak to a doctor first.

How common is diabetes in Pakistan?

Very common. The International Diabetes Federation estimates that about 34.5 million Pakistani adults have diabetes, with the highest age-standardised prevalence in the world at 31.4 per cent. About 9.3 million people with diabetes in Pakistan do not know they have it.

Does exercise help even without a strict diet?

Yes. Regular physical activity improves blood sugar control, heart health and weight, even without a very low-calorie diet. The RESET trial combined diet and exercise, but doctors recommend physical activity for almost everyone with type 2 diabetes. Brisk walking is a good place to start.

Conclusion

The RESET for Remission trial is a hopeful result for a worrying trend. Type 2 diabetes is striking younger people, and when it starts young it is more aggressive and harder to live with. The trial shows that, for many young adults, the disease can be pushed back — not with a new drug, but with a structured programme of eating less and moving more, under medical supervision.

The trial was small and short, and remission is not a cure. But 54 per cent against 4 per cent is a striking difference, and it points to a clear message: the earlier diabetes is caught, and the more structured the support, the better the chances of turning it around. For Pakistan, where a third of adults live with diabetes and millions do not know they have it, the first step is the simplest one — getting tested.

Disclaimer: This article is general information only and is not medical advice. It describes a clinical trial and general lifestyle information. Do not start a very low-calorie diet, an exercise programme or any diabetes treatment without consulting a qualified doctor. If you have symptoms of diabetes — such as excessive thirst, frequent urination, unexplained weight loss or constant tiredness — please seek medical advice.

Sources

• Drugs.com (HealthDay), “Diet And Exercise Can Reverse Early-Onset Type 2 Diabetes” (5 October 2026). https://www.drugs.com/news/diet-exercise-can-reverse-early-onset-type-2-diabetes-131539.html
• Medical Xpress, “Low-calorie diet and exercise put early-onset type 2 diabetes in remission for 54% of participants” (2 October 2026). https://medicalxpress.com/news/2026-10-calorie-diet-early-onset-diabetes.html
• Dasgupta K, Bouldé 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 (2026). DOI: 10.1016/j.lana.2026.101664
• International Diabetes Federation, Diabetes Atlas, 11th edition (2025) — Pakistan country data, as reported by Medical News Pakistan. https://www.medicalnews.pk/02-Dec-2025/pakistan-tops-global-list-for-diabetes-prevalence-2025
• World Health Organization, “Diabetes” (fact sheet). https://www.who.int/news-room/fact-sheets/detail/diabetes