Alongside the diet, participants did twice-weekly supervised exercise combining aerobic and resistance training, plus one independent session per week during the first 12 weeks. From weeks 13 to 24, they switched to a weight-maintenance diet with independent exercise. The 46 control participants received usual care.

Participants stopped all glucose- and blood pressure-lowering medication when they started the diet, unless they had albuminuria — protein in the urine that signals kidney damage.

The researchers defined remission as glycated hemoglobin (HbA1c, a measure of average blood sugar over roughly three months) below 6.5% (48 mmol/mol), while taking no glucose-lowering medication for at least 12 weeks.

Substantial weight loss, muscle preserved

At 24 weeks, 27 of 50 intervention participants (54%) were in remission, versus 2 of 46 controls (4%).

The intervention group started at a mean weight of 100.7 kg and lost an average of 8.4 kg, finishing at 92.3 kg. The control group started at 103.2 kg and lost just 1.2 kg on average, ending at 102.0 kg. After adjustment, the intervention group lost 7.5 kg more than controls, including 6.6 kg more fat mass.

The trial recorded no severe adverse events. Most intervention participants experienced at least one adverse event (43 of 50 versus 6 of 46 in the control group), mainly early effects of the low-energy diet such as constipation, headache, dizziness, and fatigue, all of which resolved.

"Our findings demonstrate the feasibility and efficacy of combining structured aerobic and resistance exercise with a low-energy diet in early-onset type 2 diabetes, supporting its potential to deliver substantial and holistic health and well-being benefits alongside diabetes remission," the authors say.

"Our remission rates are at the upper end of those previously reported in the literature for trials of similar duration, reinforcing the potential of structured lifestyle interventions to support clinically meaningful remission, while demonstrating for the first time that such effects can be achieved in a multi-ethnic population with early-onset type 2 diabetes through a combined low energy diet and structured exercise intervention."

Why muscle matters for the long term

The researchers highlight a well-known problem: most people regain some or all of the weight after any weight-loss program, including low-energy diets for diabetes remission. Weight loss driven by calorie restriction alone reduces both fat and fat-free mass — muscle, in plain terms. Some evidence suggests the weight that comes back is preferentially fat rather than muscle, leaving a net loss of muscle over time and raising the risk of sarcopenia, the age-related decline in muscle mass and strength.

"Our RESET for Remission study targeted muscle during the intensive weight loss phase through resistance training, and our findings indicate fat-free mass and muscle preservation is achievable with rapid weight loss," the authors say. "Preserving muscle during remission-oriented weight loss may have important implications for long-term metabolic health, physical function, and disease trajectory. This requires examination in a longer-term study."

Limitations and what comes next

The trial lasted only 24 weeks, so it cannot yet say whether remission persists, or whether muscle preservation translates into lasting metabolic benefits. The authors themselves call for longer-term evaluation in real-world settings, noting that weight regain is common. The open-label design, while necessary for this type of intervention, is also a limitation, though the endpoint assessment was blinded.

Still, the findings carry weight for a growing patient population. "By focusing specifically on early-onset type 2 diabetes, our trial addresses a growing clinical population, characterized by elevated cardiovascular disease risk, greater cumulative complication burden, and poor long-term outcomes," the authors conclude.

"In summary, RESET for Remission demonstrated that in early-onset type 2 diabetes, combining structured aerobic and resistance exercise with a low-calorie diet produces high remission rates, induces fat loss while preserving muscle mass, improves muscle quality and function, enhances cardiovascular health, and leads to meaningful improvements in patient-reported outcomes."

"As the prevalence of early-onset type 2 diabetes rises globally, our findings highlight an opportunity to re-evaluate treatment paradigms and support scalable implementation of integrated dietary and exercise interventions for remission. Our approach may be particularly valuable in those seeking or with potential for pregnancy. It warrants further evaluation in longer term studies in real-world settings."