In a 96-person randomised trial presented at EASD and published in The Lancet Regional Health – Americas, 27 of 50 adults under 45 reached remission on a low-calorie diet plus supervised exercise, versus 2 of 46 on usual care.
A randomised clinical trial reports that a structured programme of a very low-calorie diet and supervised exercise put early-onset type 2 diabetes into remission in 54% of participants after 24 weeks, compared with about 4% receiving usual care. According to a summary of the research, the results were presented at the annual meeting of the European Association for the Study of Diabetes and published in The Lancet Regional Health – Americas. The study was led by Professor Kaberi Dasgupta of McGill University and Professor Thomas Yates of the University of Leicester, with centres in England and Canada. It enrolled 96 adults aged 18 to 45 with type 2 diabetes and obesity who were not using insulin: 27 of 50 in the intervention group reached remission against 2 of 46 on usual care, which the authors calculate as 21 times the likelihood after adjustment.
The intervention combined 800 to 900 calories a day with supervised aerobic and resistance exercise twice a week plus one independent session for the first 12 weeks, followed by a weight-maintenance diet with continued exercise until week 24. Remission meant an HbA1c below 6.5% (48 mmol/mol) with no glucose-lowering medication for at least 12 weeks, and participants with missing data counted as not in remission. Average weight fell from 100.7 kg to 92.3 kg in the intervention group while the usual-care group lost 1.2 kg; after adjustment the gap was 7.5 kg, including 6.6 kg of fat. No severe adverse events were reported, but at least one adverse event occurred in 43 of 50 intervention participants versus 6 of 46 controls, mostly early symptoms such as constipation, headache, dizziness and fatigue that generally resolved.
The researchers caution that the trial was open-label, so participants and investigators knew who received which treatment, although the main outcome was assessed blind, and that the sample was small with only six months of follow-up. Remission here means blood sugar fell below the diagnostic threshold without drugs, not that the disease is permanently cured, and weight regain is a recognised risk after very low-calorie diets. The authors describe their remission rate as at the upper end of those reported in similar short trials and say it is the first to show such an effect in a multi-ethnic population with early-onset disease, a form that tends to progress faster and bring earlier complications. They say the combined approach supports further study of whether the benefits last.
