Remission of type 2 diabetes depends on time since diagnosis and low-calorie diet composition: Results of a randomized controlled trial in individuals with overweight and obesity.

AIMS: To investigate the impact of diabetes duration and different nutrient profiles on type 2 diabetes remission (T2DR) in response to very low-calorie diets (VLCDs).

METHODS: Participants with a BMI > 27 kg/m and diabetes duration of ≤ 4 years or ≥ 8 years were studied before and after a VLCD (600-800 kcal/day) for three months, including discontinuation of antidiabetic medication. Individuals were randomly assigned to one of two VLCDs with slightly different macronutrient composition.

RESULTS: T2DR, defined as plasma fasting glucose < 126 mg/dl, was achieved in 34 of 47 participants (72%). Despite similar weight loss of subjects with short and long diabetes duration (-15.2 ± 5.8 kg vs. -13.9 ± 4.8 kg; p = 0.473), subjects with long diabetes duration had a 32% lower remission rate (82% vs. 50%; p = 0.027).T2DR was found to be higher with the high-fiber, high-protein, and low-carb, low-fat formula diet (91% vs. 56%; p = 0.008). Individuals that achieved T2DR had significantly lower fasting plasma glucose and higher C-peptide levels at baseline.

CONCLUSIONS: Fasting plasma glucose, C-peptide levels, diabetes duration, and used macronutrient profile emerged as important factors for the achievement of T2DR, although a considerable remission is still possible after long duration of type 2 diabetes.

Copyright © 2026 The Author(s). Published by Elsevier B.V. All rights reserved.

PMID: 41698509