A type 2 diabetes diagnosis in your 30s or early 40s does not have to mean a lifetime of ever-increasing medication. A randomised trial published in October 2026 in The Lancet Regional Health – Americas found that a six-month programme combining a very low-calorie diet with supervised exercise put just over half of young adults into type 2 diabetes remission, meaning their HbA1c fell below the diabetes threshold with no glucose-lowering medication at all. Here is what the study found, who it applies to, and how blood tests tell you whether remission is real.
What the RESET for Remission trial found
The RESET for Remission trial was run by the University of Leicester in England, McGill University in Montreal and the University of Alberta in Edmonton. It enrolled 96 adults aged 18 to 45 who had early-onset type 2 diabetes and obesity and were not using insulin. Half received usual care. The other half followed a structured programme:
- Weeks 1 and 2: all meals replaced with nutritionally complete formula products, under medical supervision.
- Weeks 3 to 12: about 800 to 900 calories a day with one regular meal, plus two supervised workouts a week (aerobic and strength training) and one session on their own.
- Weeks 13 to 24: a weight-maintenance eating plan with continued exercise.
Diabetes medicines were stopped by the care team at the start. Remission followed the international definition: an HbA1c below 6.5% (48 mmol/mol) at 24 weeks, with no glucose-lowering medication for at least 12 weeks.
The result: 27 of 50 people on the programme (54%) were in remission at six months, compared with 2 of 46 (about 4%) in usual care. Programme participants lost a little over 8 kg (about 1 st 4 lb) on average, mostly fat, while keeping their muscle mass and improving strength and fitness. There were no serious adverse events. Common early side effects such as constipation, headache, dizziness and fatigue faded as the diet went on.
The authors are careful about limits: the trial was small, open-label (participants knew which group they were in) and short. It does not tell us yet how long remission lasts once the programme ends.
Why early-onset type 2 diabetes matters
Diabetes that starts at 30 or 40 means more years of high blood sugar, and therefore a higher lifetime risk of heart, kidney, eye and nerve complications. It is also the stage when the disease is most reversible, because the pancreas can still make a meaningful amount of insulin. Earlier trials, including DiRECT in the UK and DiRECT-Aus in Australia, showed that substantial weight loss on a low-calorie diet could put type 2 diabetes into remission in roughly half of participants at one year. What RESET for Remission adds is structured exercise in a younger group, with better preservation of muscle.
In the United States, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) uses the same HbA1c cut-offs to diagnose diabetes, so the remission threshold maps directly onto the test your GP already orders. A programme like this is not a do-it-yourself plan: an 800-calorie diet combined with glucose-lowering drugs can cause dangerous lows, so any change to your medicines must be made by your GP or diabetes team.
Remission is not a cure
Experts use the word remission, not cure, because diabetes can come back, especially with weight regain. The five-year follow-up of DiRECT shows this clearly: some people who were in remission at two years were still in remission at five, but many had seen their blood sugar rise again. England's national NHS Path to Remission programme, which delivers this approach at scale, reports lower remission rates than the trials but confirms that remission is achievable outside research settings. That is why anyone in remission still needs regular blood tests.
Recent research advances: what this changes for you
Studies published since 2023 send a fairly consistent message. First, remission depends mainly on how much weight is lost and whether it stays off: the larger and more durable the loss, the better the chance that blood sugar stays normal. Second, timing matters: results are better when diabetes is recent, before the insulin-producing cells are worn out. Third, exercise changes the quality of weight loss: by protecting muscle, it helps the body use sugar more efficiently, which may make results easier to maintain.
In practical terms, if you were diagnosed with type 2 diabetes recently, it is reasonable to ask your GP whether remission is a realistic goal for you. The answer depends on your age, how long you have had diabetes, your weight, your current medications and any other conditions.
Which tests can monitor or screen for this?
Remission is confirmed by blood tests, not by how you feel.
| Test | What it measures | Role in remission |
|---|---|---|
| HbA1c (A1C) | Average blood sugar over about 3 months | Below 6.5% at least 3 months after stopping medication |
| Fasting plasma glucose | Blood sugar after an overnight fast | Backup measure when HbA1c is unreliable (anaemia, some blood disorders) |
| Fasting insulin and HOMA-IR | How resistant the body is to insulin | Not an official criterion, but useful to track metabolic improvement |
| Lipid profile | Cholesterol and triglycerides | Often improves with weight loss |
| Urine albumin and eGFR | Kidney health | Still monitored during remission |
Liver enzymes such as ALT also reflect liver fat, which is common with type 2 diabetes and usually falls with weight loss. The international consensus on remission recommends checking HbA1c at least once a year in anyone who is in remission.
When to see a doctor
- Before starting any very low-calorie diet or changing your diabetes treatment. Never stop medication on your own.
- If you are constantly thirsty, urinating often, losing weight without trying or unusually tired, which can signal high blood sugar.
- If you are in remission and a follow-up HbA1c or fasting glucose starts to rise.
- If you feel faint, confused or are vomiting during a strict diet: seek urgent medical help or call 999.
Glossary
- Diabetes remission: an HbA1c below 6.5% measured at least three months after stopping all glucose-lowering medication.
- HbA1c (A1C): the share of haemoglobin bound to sugar, reflecting average blood sugar over the past three months.
- Early-onset type 2 diabetes: type 2 diabetes diagnosed before about age 40 to 45, depending on the study.
- Low-energy diet: an eating plan of roughly 800 to 900 calories a day, often based on meal replacements, used for a limited time under medical supervision.
- Insulin resistance: reduced sensitivity of cells to insulin, which forces the pancreas to make more of it.
- Open-label trial: a study in which participants and staff know which treatment is being given.
Frequently asked questions
Can type 2 diabetes be reversed?
Doctors prefer the term remission: blood sugar returns to normal without medication, but diabetes can come back, especially with weight regain. Lifelong blood testing is still needed.
Can exercise alone put diabetes into remission?
Exercise clearly improves blood sugar, but the remissions seen in trials rely mostly on substantial weight loss. RESET for Remission tested diet and exercise together.
Which blood test proves remission?
The HbA1c test. It must be below 6.5% at least three months after stopping diabetes medication, and it should then be rechecked regularly.
Is this programme right for everyone?
No. It was tested in adults aged 18 to 45 with obesity and recently diagnosed diabetes who were not on insulin. Older adults, people using insulin or those with other health conditions should discuss options with their GP.
Do I need to stop my medication to try for remission?
Only under medical supervision. In the trial, medication changes were managed by the care team, because a strict diet combined with some diabetes drugs can cause low blood sugar.
Sources
- Dasgupta K, Yates T 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
- Lean MEJ et al. 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT). The Lancet Diabetes & Endocrinology, 2024. DOI: 10.1016/S2213-8587(23)00385-6
- Valabhji J et al. Early findings from the NHS Type 2 Diabetes Path to Remission Programme. The Lancet Diabetes & Endocrinology, 2024. DOI: 10.1016/S2213-8587(24)00194-3
- Hocking SL et al. Intensive Lifestyle Intervention for Remission of Early Type 2 Diabetes in Primary Care in Australia: DiRECT-Aus. Diabetes Care, 2024. DOI: 10.2337/dc23-0781
- Riddle MC et al. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care, 2021. DOI: 10.2337/dci21-0034
- National Institute of Diabetes and Digestive and Kidney Diseases. The A1C Test & Diabetes
- Healio. Low-energy diet plus exercise could help adults with type 2 diabetes achieve remission, 7 October 2026
Other articles
- Diabetes: Symptoms, Causes, Diagnosis, and Treatment
- HbA1c Conversion Chart: Turn Your HbA1c Into Average Glucose
- Prediabetes Diet and Liver Fat: What a New Trial Found
- Glucose Spikes After Eating: What a New Heart Risk Study Found
- Insulin Resistance Without Obesity: What Your Blood Tests Reveal
- Glucose Monitors and Kidney Health: What the New Study Shows
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