You probably know someone with type 2 diabetes, or have been told your own numbers are drifting the wrong way.
For most people, the message after diagnosis is the same. It is a long-term condition, and you will likely be on medication for the rest of your life.
A new trial published in The Lancet Regional Health Americas suggests that assumption may need revisiting, at least for younger adults diagnosed early.
More than half of participants on an intensive 24-week diet and exercise program sent their type 2 diabetes into remission, without medication.
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The trial, called RESET for Remission, enrolled 96 adults aged 18 to 45. All had early-onset type 2 diabetes and obesity, and none were using insulin.
Researchers ran it across three centers. McGill University in Montreal, the University of Alberta in Edmonton, and the University of Leicester in the UK.
The 6-month program
For the first 12 weeks, participants ate between 800 and 900 calories a day. The first two weeks were meal replacements only.
From week three, one normal meal a day was added back in.
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Exercise ran alongside the diet. Twice a week, people did supervised aerobic and resistance training, with one more session on their own each week.
The last 12 weeks shifted to a food-based maintenance diet. Participants kept the independent exercise going.
The remission bar was strict. Participants had to bring HbA1c, a measure of average blood sugar over the past three months, below 6.5 percent, and keep it there for at least 12 weeks without any glucose-lowering drugs.
At the end of six months, 27 of 50 people in the intensive program had reached that bar. In the standard-care group, 2 of 46 did. That worked out to about 21 times higher odds in the lifestyle group.
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Weight loss and muscle both moved in the right direction
On average, people in the intensive group lost 8.4 kilograms, or about 18.5 pounds, over the six months.
The usual-care group lost 1.2 kilograms. Most of that extra weight loss came off as fat, not muscle.
That matters because rapid weight loss often shrinks muscle too, which can slow metabolism and make the loss harder to keep off.
The resistance-training piece was designed to protect muscle while calories were low.
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According to the research team at the McGill University Health Centre, the intensive group also lost more than 9 percent of their liver fat.
Visceral fat, the kind packed deep around the organs, dropped by more than 24 percent.
Fitness, measured against body weight, improved by about 10 percent.
The trial was led by Kaberi Dasgupta of McGill University and Tom Yates of the University of Leicester.
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They concluded that the combined approach can deliver remission alongside broader cardiovascular and muscle benefits in people this age.
What the trial does not prove
It was a small trial, with 96 people, and ran for only six months. Longer follow-up is still needed to see whether remission holds up once participants are out of a supervised program.
Side effects were common in the strict phase. 43 of the 50 people in the intensive group reported at least one issue, usually constipation, headaches, dizziness or fatigue.
Most eased as the diet opened up again. No serious adverse events were reported.
Remission is not the same as a cure. Blood sugar has fallen below the diabetes threshold and stays there off medication, but the underlying tendency can return if weight comes back on.
Anyone considering a very low-calorie diet or a sharp change in exercise should run it past their own doctor first, especially if they already take medication for diabetes or blood pressure.
This article is made and published by Ida-Marie Palm Varbæk, who may have used AI in the preparation.