At study centers in Montreal, Edmonton, and Leicester, researchers compared in a randomized study in 18- to 45-year-olds with obesity and type 2 diabetes a group with structured training and low-calorie diet to a group receiving standard care. After 24 weeks, 54 percent of the intervention group achieved remission. In the control group, it was 4 percent. Remission was defined, according to Medscape, as an HbA1c value below 6.5 percent without glucose-lowering medication for at least twelve weeks. Study author Kaberi Dasgupta from McGill University in Montreal presented the results; the study also appeared in The Lancet Regional Health, Americas.
How the Program Was Structured
The basis was a study protocol published in BMJ Open in 2022 for young adults with obesity whose type 2 diabetes had been diagnosed within the previous six years and who were not receiving insulin therapy. In fact, 96 people participated. They had a mean age of 38 years and a body mass index averaging 35.2, according to Medscape. Physicians speak of early-onset type 2 diabetes when diagnosed at age 45 or younger, which carries a more aggressive course and higher risk of complications and mortality. In the twelve-week intensive phase, the intervention group could consume only 800 to 900 calories daily, according to the Pharmazeutische Zeitung; in the following twelve weeks it switched to a weight-maintaining diet based on individual dietary counseling. Additionally, the group completed one hour of strength and endurance training twice weekly; a third session was to be completed independently, while the control group received standard medical care. Over the subsequent twelve weeks, the intervention group continued training independently.
What the Numbers Show
After 24 weeks, the intervention group had lost an average of 8.4 kilograms of body weight. The control group lost a mean of 1.2 kilograms. The researchers found no distinct differences between the groups in muscle volume and lean mass. For the primary endpoint, 27 of 50 participants in the intervention group achieved remission, according to ScienceAlert. In the control group, two of 46 participants achieved remission. After twelve weeks, blood pressure had normalized in 63 percent of the intervention group versus 13 percent of the control group. After 24 weeks, the differences between groups were smaller. Still, 56 percent of the intervention group compared to 27 percent of the control group were considered in blood pressure remission. Most participants in the intervention group experienced adverse events such as constipation, headaches, dizziness, or fatigue; no serious events were reported, according to Medscape.
How Reliable the Results Are
The study was open-label, without blinding of participants and treatment providers; it also did not separately compare the combination of diet and training from its individual components. The study authors themselves named the absence of a third comparison group with diet alone as a central limitation. This corresponds to a rate of 90 percent. Commenting professor Roy Taylor assessed the training supervision in the study, according to Medscape, as exemplary for demonstrating biological feasibility; he considered repetition under financially limited everyday conditions very difficult.
Comparison: Other Diabetes Remission Programs
How much the result depends on study conditions and time period is evident when compared with two longer-running projects. Of the 36 participants in the original DiRECT intervention group who had lost more than ten kilograms after two years, 29 were in remission. The authors of the care study of the NHS Type 2 Diabetes Path to Remission Programme concluded that remission was possible outside of research conditions; however, they noted that the achieved rate was lower and data collection was more limited than under the conditions of randomized trials.
Open Questions for Further Studies
First author Kaberi Dasgupta from McGill University in Montreal acknowledged that weight regain after such diets has been observed in research. The researchers also note that it remains unclear whether the results can be transferred to other patient groups with type 2 diabetes. It is also possible that remission does not persist after structured support is withdrawn. The possible long-term benefit of the observed muscle preservation for metabolism, physical function, and disease course must, according to the researchers, first be examined in a longer study. For future investigations, the authors propose testing diet and exercise separately as well as in combination to determine the contributions of individual components.