Low-Energy Diet Plus Structured Exercise Reverses Early Onset Diabetes
A low-energy diet combined with a structured exercise program led to early onset type 2 diabetes remission. FreshSplash/E+/Getty Images
A new study found that a low-energy diet and exercise reversed early onset type 2 diabetes in half of the participants.
This is important because early onset diabetes can lead to earlier health decline and other complications.
Experts suggest eating a good-quality diet and reducing calories by about 500–700 daily to lose weight.
Aim for 150 minutes of moderate-intensity physical activity each week.
A new study has found that a combination of a low-energy diet and structured exercise reversed early onset type 2 diabetes in about half of participants.
The research focuses on adults under 45 years old who developed type 2 diabetes early in life. The authors presented their findings at the European Association for the Study of Diabetes (EASD) Annual Meeting, held September 28 to October 2. The study was published on October 1 in The Lancet Regional Health Americas.
Type 2 diabetes is a condition in which the body becomes less able to respond to insulin or has difficulty producing it, leading to elevated blood sugar and low energy. If untreated or not properly managed, it can lead to serious complications such as vision problems, kidney disease, and nerve damage.
These findings offer hope for better treatment options for people with this condition, which the authors say is known for causing faster health decline when compared to later-onset diabetes.
Effects of a low-energy diet plus exercise on early onset diabetes
The study was conducted at three centers in England and Canada, linked with the University of Leicester, McGill University, and the University of Alberta.
Researchers selected adults ages 18 to 45 who had early onset type 2 diabetes and obesity but were not using insulin therapy.
A total of 96 participants were randomly divided into two groups: one received usual care, and the other took part in a program combining a low-energy diet with supervised and independent exercise.
The intervention group followed a strict diet of 800-900 calories per day, consisting of 30% protein, 50% carbohydrates, and 20% fat. Participants were encouraged to drink at least 2 liters of calorie-free fluids daily and were given a fiber-based laxative if needed.
For the first two weeks, the diet was entirely based on meal replacements (Optifast). From week 3 to week 12, the same calorie limit was maintained, with greater food variety, including one meal per day made from regular foods such as protein sources, one portion of fruit, and two portions of non-starchy vegetables.
The exercise program involved supervised aerobic and resistance training twice a week and one session of independent exercise per week during the first 12 weeks. After this, from weeks 13 to 24, participants followed a weight-maintenance diet and exercised independently.
Participants stopped all glucose– and blood pressure-lowering medications at the start of the diet unless they had a specific kidney condition called albuminuria (high levels of a protein called albumin in the urine).
The main goal of the study was to determine how many participants achieved remission of their diabetes after 24 weeks. Remission was defined as having a blood sugar level below the diabetes threshold (measured by glycated hemoglobin or HbA1c less than 6.5%) and not taking any diabetes medication for at least 12 weeks.
The study also examined secondary outcomes such as fitness levels, body composition, and heart health.
Diet-exercise combo led to remission in 54% of participants
After 24 weeks, 54% of participants in the diet and exercise group achieved remission, compared with only 4% in the usual care group.
They also lost weight. The diet and exercise group lost an average of 8.4 kilograms (about 18.5 pounds), while the usual care group lost only 1.2 kilograms (about 2.6 pounds).
After adjusting for various factors, the diet-and-exercise group lost about 7.5 kilograms more than the control group.
Additionally, most of this weight loss was fat, with about 6.7 kilograms of fat lost at 24 weeks, which the researchers note is important for improving diabetes.
According to the researchers, the intervention helped preserve muscle mass, which is usually lost during weight loss. This is significant because maintaining muscle is important for long-term health, strength, and metabolism.
They further highlighted that early onset type 2 diabetes can cause serious health problems at a young age.
However, their study shows that a combined approach of diet and exercise can not only help people lose weight and improve health but can also lead to real remission of diabetes, without needing medication.
This is important because early onset type 2 diabetes usually worsens quickly and is harder to manage than diabetes that starts later in life.
The researchers additionally believe their approach could be especially helpful for younger adults who may be planning to have a child, as managing diabetes early is critical for health during and after pregnancy.
The study’s success in a multi-ethnic population also adds to its significance, showing the program could work for diverse groups.
The researchers noted that most people in the diet-and-exercise group experienced side effects early in the program, including constipation, headaches, dizziness, and fatigue. However, these were mostly mild and resolved over time.
Managing your health with type 2 diabetes
Avery Zenker, a registered dietitian and medical writer, explained the importance of this work. “We have evidence that type 2 diabetes doesn’t have to be an inevitably progressive disease,” Zenker told Healthline.
“This can give hope for people with diabetes and help empower them to make impactful lifestyle changes.”
Zenker, who was not involved in the study, added that type 2 diabetes remission is not only possible but more likely in younger people who tend to have a shorter disease duration and a less complicated health history.
Jennifer Pallian, BSc, a registered dietitian and founder of Foodess, who wasn’t involved in the research, said that you can put these findings into action right now.
First, you can start a lower-calorie diet. “A reasonable target used in the research was to reduce daily calorie intake by about 500–750 calories, with the goal of losing at least 5% of starting body weight,” she told Healthline.
Zenker noted there are other factors to consider besides the number of calories. “There’s a big difference between a low calorie diet that’s predominantly whole foods compared to one that’s mostly ultra-processed and nutrient-poor,” she said.
“It’s important to consider other recommendations like whole foods, high fiber, and reduced intake of ultra-processed foods.”
Along with making dietary changes, Pallian advised working toward getting at least 150 minutes of moderate-intensity activity per week. “It also helps to make the plan measurable,” she said. “Set specific nutrition and activity goals, keep track of what and how much you eat, and record your physical activity too.”
Pallian suggested taking note of situations where it’s harder to stay on track so you can spot patterns and make adjustments.
Zenker further noted the importance of starting small and not feeling as if going to the gym is the only way to get exercise.
“Some simple ways one might start to increase daily activity could include adding a short body weight routine in the morning, taking a short walk after a meal, or dancing to music at home,” she said. “Even activities like yard work or cleaning the house can count as physical activity.”
Finally, Pallian advised regular visits with a healthcare professional to monitor blood sugar and blood pressure. These values may improve with weight loss, which may require your doctor to adjust your medication regimen.
