Type 2 diabetes is not necessarily a lifelong diagnosis or a disease that gets progressively worse over time.
Today, there is strong evidence to suggest that the risk of developing this metabolic disorder can be reduced by up to 58 percent in people who have prediabetes.
Diet and exercise are a key part of that.
Researchers in the United Kingdom (UK) and Canada have now identified a way to put more than 50 percent of patients with early onset type 2 diabetes into remission.
It involves a low-calorie diet and a supervised exercise program.
"Our remission rates are at the upper end of those previously reported in the literature for trials of similar duration," the authors write, led by Kaberi Dasgupta at McGill University in Canada.
These findings, the team argues, reinforce the potential of lifestyle interventions to "support clinically meaningful remission".
They also demonstrate "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."
Early-onset type 2 diabetes is often defined as a diagnosis at 45 years of age or younger, and it tends to progress more rapidly than cases that come on later in life.
Patients with early-onset diabetes show accelerated deterioration in glucose levels and they face an increased risk of premature health complications and death.
In some cases, however, positive changes can be made.
The randomized trial took place at three centers in Canada and the the UK and included 96 participants of various ethnicities with early onset type 2 diabetes and obesity, who were not on insulin therapy.
The average age of the group was 38.
In the current trial, roughly half the group was randomized to continue their lives as per normal, while the other half began a low-energy diet and exercise intervention.
The diet involved eating roughly 800–900 calories a day, and the exercise intervention involved a twice-weekly supervised session of aerobic and resistance training, and a once-weekly independent exercise.
The health of participants was closely supervised.
After 12 weeks, participants switched to a weight-maintenance diet and continued exercising independently for a further 12 weeks.
At 24 weeks, remission was achieved in 27 out of 50 participants within the intervention group.
By comparison, only two participants in the control group entered remission.
That's a difference of 50 percent, and it was all achieved without glucose-lowering medicine.
Participants in the intervention group achieved substantial fat mass loss compared to the control group, but crucially, they also preserved muscle mass and strength.
By the end of the trial, their cardiovascular health showed several improvements, including a 10.3 percent increase in respiratory fitness relative to body mass, and a lower resting blood pressure and heart rate.
The left ventricles of the heart also appeared to be a healthier shape and structure compared to the control group.
In surveys, participants reported that their distress from diabetes had decreased and their quality of life had increased.
"Our findings demonstrate the feasibility and efficacy of combining structured aerobic and resistance exercise with low-energy diets in early onset type 2 diabetes," the authors conclude, "supporting its potential to deliver substantial and holistic health and well-being benefits alongside diabetes remission."
The trial only lasted 24 weeks, so it is unclear how long these benefits might last for.
At this point, it's also unclear whether diet or exercise played a larger role.
While other trials have considered how a low-energy diet might put early onset type 2 diabetes into remission, focusing solely on weight loss may risk a loss of muscle mass.
Muscle is important for metabolic health. It is a primary site of glucose disposal, and it is also a major determinant of how the body responds to insulin.
When too much fat is deposited in muscle, some studies suggest it can impair insulin signalling.
The authors of the recent trial suggest that future studies randomize participants to receive a low-energy diet or an exercise intervention, as well as both at the same time, to see how all three outcomes compare.
"Our findings indicate fat-free mass and muscle preservation is achievable with rapid weight loss," the team concludes.
"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."
The research has been published in The Lancet Regional Health – Americas.
This article was fact-checked by Fiona MacDonald and edited by Fiona MacDonald. While we pride ourselves on our process, we are only human. If you spot a mistake, please let us know.