A low-calorie diet combined with regular exercise has helped more than half of young adults with early-onset type 2 diabetes achieve remission, raising fresh hopes for a non-drug approach to managing the disease.
The finding comes from the randomised RESET for Remission trial, which followed 96 adults aged 18 to 45 who had been diagnosed with type 2 diabetes within the previous six years.
Researchers found that 54 per cent of participants placed on an intensive diet-and-exercise programme achieved diabetes remission after 24 weeks, compared with only four per cent of those receiving routine clinical care.
Remission was defined as reducing HbA1c, a measure of average blood sugar, below 6.5 per cent without the use of glucose-lowering medication for at least 12 weeks.
The intervention began with an 800 to 900-calorie daily meal-replacement diet, twice-weekly supervised aerobic and resistance exercise, and an additional weekly independent exercise session.
Participants subsequently entered a 12-week maintenance phase involving a nutritionally balanced diet, gradual reduction of meal replacements, and continued exercise.
Despite the demanding programme, adherence was high, with 90 per cent of participants completing the final assessment.
The researchers said the benefits extended beyond blood sugar control.
Participants recorded reductions in visceral and liver fat, as well as improvements in pancreatic and muscle fat levels. They also experienced improvements in handgrip strength, blood pressure, triglycerides, quality of life and diabetes-related distress.
Hypertension remission was achieved by 56 per cent of participants in the intervention group, compared with 27 per cent in the usual-care group.
Kaberi Dasgupta, MD, MSc, of McGill University in Montreal, who presented the findings at the annual meeting of the European Association for the Study of Diabetes in Milan, said the programme demonstrated that intensive lifestyle intervention could be feasible even when it demands a significant commitment from patients.
Early-onset type 2 diabetes, generally defined as diagnosis before age 45, is associated with faster deterioration in blood sugar control and a greater lifetime risk of complications.
The researchers also highlighted differences between overall weight loss and improvements in body composition.
Participants in the RESET trial lost about 16.5 pounds over 24 weeks, less than the 28.4 pounds reported over 52 weeks with tirzepatide in the SURPASS-3 trial. However, RESET participants experienced substantial reductions in visceral and liver fat.
Thomas Yates, PhD, of the University of Leicester, said the findings reinforce the importance of looking beyond the number on the weighing scale when assessing the benefits of exercise.
No serious adverse events were reported. Some participants experienced temporary headaches, constipation, dizziness and fatigue when beginning the low-calorie diet, while mild infections were slightly more common in the intervention group.
The findings were presented at the EASD annual meeting and published simultaneously in The Lancet Regional Health – Americas.
Researchers, however, stressed that further studies are needed to determine how much of the benefit came specifically from exercise, since the trial tested diet and exercise together.
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