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Type 2 diabetes is often stereotyped as an elderly disease, but young people can sometimes get it too. For someone diagnosed in their 20s or 30s, it can mean many years of strictly regimented medication and a growing risk of damage to the heart, kidneys, and other organs. But a new clinical trial suggests that it is possible, in some cases, to control diabetes with something as straightforward as dieting and physical exercise.
After six months, 27 of 50 adults (54 percent) assigned to an intensive diet-and-exercise program had brought their blood sugar below the threshold for diabetes without taking glucose-lowering medication for at least three months. By comparison, only 4 percent of those who continued their regular diabetes treatment went into remission.
To be clear, the scientists are referring to remission rather than a cure. Blood sugar can rise again, especially if the patient returns to their typical eating and sedentary habits. Still, this intervention — difficult as it may be, as you shall find out — offers a possible route to remission for younger people, whose diabetes often progresses faster and brings complications earlier than disease diagnosed later in life.
Twelve weeks of shakes, walks and weights
The researchers recruited 96 adults at centers in Britain and Canada. Their average age was 38, all were living with obesity, and none had been diagnosed with type 2 diabetes more than six years earlier.
For the first 12 weeks, the intervention group followed a tightly controlled diet of 800 to 900 calories a day, with extra calories recommended on exercise days. That’s less than half the daily energy needs of most adults (let alone someone with obesity), making it an exceptionally restrictive regimen that can be difficult to sustain. For two weeks, they consumed only meal-replacement products. After that, they could eat one ordinary meal a day alongside replacements.
Beginning in week three, they also attended two supervised exercise sessions each week, combining aerobic activity, mostly walking, with strength training. A third session was completed independently. For the final 12 weeks, participants gradually returned to regular food and continued exercising with less supervision.
Doctors monitored them closely and stopped or restarted diabetes and blood pressure medications when appropriate.
The intervention group lost an average of 7.5 kilograms (16.5 pounds) more than people receiving usual care. All 14 participants who lost at least 10 percent of their starting weight achieved remission, although that subgroup was small.
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Later, scans showed less fat in the liver, pancreas and muscles, while muscle volume was largely maintained. Compared with usual care, grip strength improved by 7.6 percent and fitness measured relative to body weight improved by 10.3 percent. Blood pressure also fell, and participants reported fewer depressive symptoms and less diabetes-related distress.
What exercise added remains unclear
Previous research has reported solid evidence that substantial weight loss can bring type 2 diabetes into remission. The British DiRECT trial found that 46 percent of people assigned to an intensive weight-management program were in remission after a year; 36 percent remained in remission at two years. A trial in Qatar involving younger adults reported 61 percent remission after one year with a low-calorie diet and physical-activity support.
What distinguishes the new study is its combination of a very low-calorie regimen with structured, supervised aerobic and strength training. In a University of Leicester statement, the researchers concluded that “our findings indicate muscle mass preservation is achievable with rapid weight loss.”
The catch is that the program was very demanding. Only 40 percent met all its adherence criteria. And while no serious adverse events occurred, 43 of 50 people in the intervention group reported at least some problems, often headaches, constipation, dizziness or fatigue. Some experienced exercise-related pain or injuries.
Most importantly, researchers stopped following participants at six months. Earlier studies show that regaining weight can bring diabetes back. Whether this program helps younger adults stay in remission for years, rather than months, is the next question and likely depends a lot on the patient’s discipline.
The findings appeared in The Lancet Regional Health – Americas.
