Randomized Trial Shows 54% Remission in Early-Onset Type 2 Diabetes With Low-Calorie Diet Plus Exercise

The open-label trial randomized participants across sites in England and Canada to usual care or a 12-week 800-900 kcal LED phase (total meal replacement then partial) followed by weight maintenance, combined with twice-weekly supervised aerobic/resistance exercise and one independent session. All glucose-lowering medications were stopped at baseline. Primary endpoint was HbA1c below 6.5% off medication for 12 weeks. Intervention participants lost 8.4 kg on average; controls lost 1.2 kg.

Early-onset type 2 diabetes progresses faster and shows earlier complications than later-onset disease, making the 21-fold adjusted odds of remission clinically meaningful. Results align with the DiRECT trial's 46% remission at one year but add exercise to preserve muscle and improve fitness, addressing a gap in prior LED-only studies. The design stopped medications proactively, reducing confounding from pharmacotherapy.

Longer follow-up is required to test durability beyond 24 weeks and whether remission reduces microvascular events. Cost-effectiveness analyses and implementation in primary care will determine scalability, particularly given the need for supervised exercise infrastructure.