Laura Pomer

November 6, 2026, 12:10 pm | Read time: 6 minutes

Type 2 diabetes was once commonly referred to as adult-onset diabetes. This outdated term is now considered misleading, as the metabolic disorder no longer affects only older individuals. Various factors can contribute to its development–even in younger people–including obesity and lack of exercise.

Also of interest: Early signs and symptoms of type 2 diabetes mellitus

Study on Early-Onset Type 2 Diabetes

The present study focused specifically on the so-called early-onset form (Early-Onset Type 2 Diabetes, EOT2D).¹ This is often defined as a diagnosis before the age of 45. The authors note that type 2 diabetes occurring at a young age is more frequently associated with a less favorable disease progression than a later diagnosis. Affected individuals have an increased risk of complications and premature death.

A potential treatment strategy for EOT2D is the attempt to achieve diabetes remission. Previous studies have already shown positive effects of calorie-reduced dietary programs.² However, the additional effects of combining such a diet with regular endurance and strength training have been scarcely studied. This is where the new study comes in, specifically targeting younger adults with type 2 diabetes and obesity. The researchers were also interested in how the program affects body composition, muscle health, physical fitness, and heart function.

Study Details

The authors conducted their study titled “RESET for Remission” at three study centers in England and Canada. The study was randomized and controlled–while the treatment was open, the results were evaluated in a blinded manner.

A total of 96 adults aged 18 to 45 participated. All had been diagnosed with type 2 diabetes for no more than six years and were obese; the average BMI was 35.2. A participation criterion was that none of the men and women had been treated with insulin. They were randomly assigned to one of two groups.

The intervention group, consisting of 50 people, completed a 24-week program with two phases:

• Phase 1 (up to week 12): highly calorie-reduced diet with 800–900 calories daily. In the first two weeks, participants consumed only meal replacement products, such as shakes. From week 3, an additional self-prepared meal per day was allowed.
  
  From this point, twice-weekly training sessions (endurance and strength) supervised by professionals began. Additionally, an extra endurance session was planned independently.
  
• Phase 2 (weeks 13 to 24): gradual return to a balanced diet and weight stabilization. Participants were to gradually transition their diet to a balanced one to maintain their weight long-term. The training was to be continued independently, for example, at home or in a gym.

No interventions took place in the control group of 46 people. Participants in this group received their usual medical care. Apparently, other diabetes medications besides insulin were not a fundamental exclusion criterion for participation.

Diabetes Remission After 24 Weeks?

The primary parameter for the researchers was whether participants achieved diabetes remission. To do so, they had to have an HbA1c level–which provides information about the average blood sugar over the past weeks–below 6.5 percent. Additionally, participants had to have been without blood sugar-lowering medications for at least 12 weeks.

Furthermore, the scientists recorded changes in both body weight and body composition, meaning the proportion of fat and muscle mass. They also examined the participants’ muscle strength, endurance capacity, and heart structure. Various methods were used for this, from stress tests to X-rays to MRI.

Results

The researchers found significant differences between the two groups. After 24 weeks, 27 out of 50 participants in the intervention group achieved diabetes remission–more than half (54 percent). At the study’s midpoint, it was even more at 58 percent, but the proportion slightly decreased afterward. In the control group, only 2 out of 46 participants, or 4 percent, achieved diabetes remission.

The results also diverged in terms of body weight. The intervention group lost an average of 7.5 kilograms more than the control group. Fat mass also decreased more significantly: the difference between the groups was 6.5 kilograms. The fat-free mass–which includes muscles–remained largely unchanged in both groups. Similarly, the muscle volume examined by MRI did not differ significantly at the end of the study.

However, other values of physical fitness and muscle health improved in the intervention group. For example, endurance capacity relative to body weight increased by 10.3 percent. Hand grip strength (a measure of muscle strength) improved by 7.6 percent compared to the control group. Additionally, myosteatosis, or fat deposits in and between the muscles, decreased.

Other health values also improved: systolic blood pressure (upper value) decreased by 4 mmHg compared to the control group, and diastolic blood pressure (lower value) by 5 mmHg. Resting heart rate decreased by 5 beats per minute. Long-term blood sugar level HbA1c and triglyceride levels–a specific form of blood fats–also developed positively.

More on the topic

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Significance of the Results

The results show that in younger adults with type 2 diabetes, an intensive combination of calorie-reduced diet and structured training can achieve a high remission rate. The improvements from the intervention are not limited to blood sugar metabolism. There were also beneficial effects on endurance capacity, muscle strength, and blood pressure, among others.

Notably, the authors write, despite significant weight loss, muscle mass was largely preserved. It is well known that severe calorie reduction often leads to muscle loss. This would be particularly problematic for people with type 2 diabetes, as the disease itself can already be associated with impaired muscle function.

In general, muscle tissue plays an important role in various bodily processes. Therefore, the reduced myosteatosis could also be significant. These fat deposits in the muscle often come at the expense of muscle quality and impair insulin action.

In summary, the results suggest that remission treatment can offer many health benefits–beyond blood sugar control. For younger patients, such improvements could be particularly significant.

Limitations

The study was relatively small, with only 96 participants and a duration of 24 weeks. It remains unclear, among other things, whether the achieved diabetes remission persisted long-term. Additionally, there is a lack of insights into how the results developed after the end of professional supervision.

A significant limitation of the study design is that there was no comparison group that received only a calorie-reduced diet. Therefore, it is not possible to assess the additional contribution of strength and endurance training to muscle preservation and improvements in fitness and muscle strength. This was actually the research question of the study. The intervention group received significantly more support from doctors, nutritionists, and training professionals. This difference alone could have influenced the recording of side effects and the results on quality of life and psychological well-being.

Finally, the results are only limitedly transferable, as only younger adults with obesity and early-diagnosed type 2 diabetes without insulin therapy participated in the study. Whether the observations would be similar in older individuals, patients with longer-standing diabetes, or people without obesity remains open.