Which Diet Puts Type 2 Diabetes Into Remission? 5 Trials

Quick answer

Both routes can work, but the strongest remission evidence is for structured low-calorie programs of about 800 to 850 calories a day. In the UK DiRECT trial, 46% reached remission at 1 year; in Qatar's DIADEM-I trial, 61% did. Low-carb diets also lower HbA1c, and 57% of people reached an HbA1c below 6.5% at 6 months in pooled trials, but fewer achieved it off all medicine. What both share is weight loss, which clears fat from the liver and pancreas.

Table of contents

1. Why weight loss can put type 2 diabetes into remission

2. The low-calorie route: 800-calorie programs and what they achieve

3. The low-carb route: what the trials show

4. Low-calorie vs low-carb: side by side

5. Remission at a normal weight: the personal fat threshold

6. How to choose, and how to stay safe

7. Staying in remission for the long term

8. Frequently asked questions

9. References

Why weight loss can put type 2 diabetes into remission

For decades, type 2 diabetes was described as a disease that always gets worse. Research from Newcastle University in the UK changed that picture.

Professor Roy Taylor's team proposed the "twin cycle" idea. Excess fat builds up in the liver and the pancreas. In the liver, it makes the body resist insulin. In the pancreas, it interferes with the cells that make insulin [2].

The DiRECT trial tested what happens when that fat goes. In people who lost weight, liver fat fell from about 16% to 3%, and pancreas fat fell too. Those who reached remission were the ones whose insulin-making cells recovered their quick response to food. They also tended to have had diabetes for a shorter time [1].

The key point is that the method of weight loss matters less than the result. Whether you get there with a formula diet, low-carb eating or another plan, losing enough weight to clear fat from these organs is what drives remission [2].

Remission is defined as an HbA1c below 6.5% (48 mmol/mol) measured at least 3 months after stopping all diabetes medicine [9].

The low-calorie route: 800-calorie programs and what they achieve

Low-calorie remission programs usually have three stages. First comes total diet replacement, where shakes and soups replace all meals for about 12 to 20 weeks at roughly 825 to 850 calories a day. Next is stepped food reintroduction over several weeks. Last is long-term support to keep the weight off [3].

DiRECT (UK)

DiRECT enrolled 298 adults in primary care who had type 2 diabetes for less than 6 years. All diabetes and blood pressure medicines were stopped at the start of the program [3].

• At 1 year: 46% in remission, versus 4% with usual care. Mean weight loss was 10 kg (22 lb) [3].

• At 2 years: 36% still in remission. Of those who kept off at least 10 kg, 64% were in remission [4].

• At 5 years: remission had fallen to 13% in those still receiving support, but the program group had more time in remission, more time off medicine and fewer than half the serious adverse events of the control group [5].

DIADEM-I (Qatar)

DIADEM-I tested a similar program in 158 younger adults (aged 18 to 50) from the Middle East and North Africa, diagnosed within the past 3 years. After 12 months, 61% of the program group were in remission, compared with 12% on usual care. A third had completely normal blood sugar [6].

Look AHEAD (US)

Not every program is this intensive. The US Look AHEAD trial used a less aggressive lifestyle program in 4,503 overweight adults with type 2 diabetes. Remission (partial or complete) occurred in 11.5% during the first year, falling to 7.3% at year 4 [7]. The difference from DiRECT and DIADEM-I shows how much the depth of weight loss and the timing after diagnosis matter.

What it's like

The shake phase removes daily food decisions, which some people find freeing and others find hard, especially at social meals. Either way, it needs medical supervision, because diabetes and blood pressure medicines usually have to be stopped or reduced on day one [3]. Support during food reintroduction is just as important as the shakes.

The low-carb route: what the trials show

Low-carbohydrate eating attracts people who don't want meal replacements. It lowers blood sugar directly, because carbs are the part of food that raises it most.

The most thorough review is a 2021 BMJ meta-analysis of 23 randomized trials with 1,357 adults with type 2 diabetes. Low-carb diets were defined as under 130 g of carbohydrate a day [8].

• HbA1c below 6.5% (48 mmol/mol), with or without medicine: Low-carb diets — 57%; Comparison diets — 31%

• Remission without any diabetes medicine: Low-carb diets — Small benefit, not statistically certain; Comparison diets — Similar

The review found other benefits at 6 months: more weight loss, lower triglycerides and better insulin sensitivity. These faded by 12 months [8].

Three caveats matter:

• Many people were still on diabetes medicine, so most of these results are "good control" rather than true remission [8].

• Remission was much less likely in studies that included people on insulin [8].

• Very strict low-carb diets (under 10% of calories) were not better than moderate ones, mainly because people found them harder to follow [8].

A related Italian trial is also worth knowing about. People newly diagnosed with type 2 diabetes who followed a lower-carbohydrate Mediterranean diet were much less likely to need diabetes medicine after 4 years than those on a low-fat diet: 44% versus 70% [10].

Low-calorie vs low-carb: side by side

• Strongest evidence: Low-calorie program (about 800 to 850 kcal/day) — DiRECT, DIADEM-I [3, 6]; Low-carb diet (under 130 g carbs/day) — Meta-analysis of 23 trials [8]

• Remission off all medicine: Low-calorie program (about 800 to 850 kcal/day) — 46% to 61% at 1 year in trials [3, 6]; Low-carb diet (under 130 g carbs/day) — Less certain; smaller difference when medicine-free [8]

• HbA1c below 6.5% at 6 months: Low-calorie program (about 800 to 850 kcal/day) — Not the main measure; Low-carb diet (under 130 g carbs/day) — 57% vs 31% [8]

• Speed of weight loss: Low-calorie program (about 800 to 850 kcal/day) — Fast: about 10 to 12 kg in the first year [3, 6]; Low-carb diet (under 130 g carbs/day) — Moderate, faded by 12 months in trials [8]

• Food: Low-calorie program (about 800 to 850 kcal/day) — Shakes and soups for 12 to 20 weeks, then food; Low-carb diet (under 130 g carbs/day) — Real food from day one

• Medical supervision: Low-calorie program (about 800 to 850 kcal/day) — Essential: medicines often stopped on day one; Low-carb diet (under 130 g carbs/day) — Advised, especially with insulin or sulfonylureas

• Best suited to: Low-calorie program (about 800 to 850 kcal/day) — Recent diagnosis, overweight, wants a structured start; Low-carb diet (under 130 g carbs/day) — Prefers real food, wants a gradual change

• Main challenge: Low-calorie program (about 800 to 850 kcal/day) — Keeping weight off afterward [5]; Low-carb diet (under 130 g carbs/day) — Sticking with it beyond 6 months [8]

The two routes are not opposites. Low-calorie programs end with a food-based maintenance plan, which can be lower in carbohydrate if that suits you. And a low-carb diet is most likely to lead to remission when it also produces enough weight loss [2].

Remission at a normal weight: the personal fat threshold

Many people with type 2 diabetes are not heavy. Advice to lose weight can seem irrelevant to them. Newer research suggests it may still help.

Taylor's team proposed a "personal fat threshold." Each person can store a different amount of fat before it spills into the liver and pancreas and causes diabetes. Someone with a normal BMI may still be above their own threshold [2].

In a study of people with type 2 diabetes and a BMI of 21 to 27, stepwise weight loss led to remission in 70%. The amount of weight loss needed varied widely from person to person [2].

This matters for lean readers. If you have type 2 diabetes at a "healthy" weight, a modest, supervised weight loss of a few kilograms may still be worth discussing with your doctor. Strength training, to build muscle that soaks up glucose, matters even more for you.

How to choose, and how to stay safe

Questions to ask yourself

1. How long have I had diabetes? Remission is more likely with shorter duration [1]. If you were diagnosed within the last few years, a structured program may be worth the effort now.

2. How much weight could I lose? In DiRECT, remission rose sharply once weight loss passed 10 kg [3].

3. Which plan can I actually follow? Both plans fail if you can't stick with them [8].

4. Do I want the structure of shakes, or would I rather eat real food?

Who should not do an 800-calorie diet without specialist advice

• People taking insulin

• Anyone who is pregnant or breastfeeding

• People with a history of eating disorders

• People with serious heart, kidney or liver disease

• Anyone with type 1 diabetes

Medicine safety

If you take insulin or a sulfonylurea (such as gliclazide or glipizide), cutting calories or carbs can cause dangerous low blood sugar. Blood pressure medicines may also need adjusting as weight falls. In DiRECT, these medicines were stopped on day one under medical supervision [3]. Do not do this on your own.

Check for program options

In England, the NHS offers a low-calorie total diet replacement program, the Path to Remission, to eligible people with recently diagnosed type 2 diabetes [11]. In the US, ask your doctor or a registered dietitian about medically supervised meal-replacement programs.

Staying in remission for the long term

Getting into remission is one challenge. Staying there is another. The 5-year DiRECT results make this clear: of people in remission at 2 years, about a quarter were still in remission at 5 years [5].

The common thread is weight. In DiRECT, people who kept off at least 10 kg had the best chance of staying in remission [4]. When people regained weight, diabetes tended to come back [2].

What helps

• Ongoing support. People who received low-intensity support for 5 years had more time in remission and off medicine than those whose support stopped [5].

• A regular weigh-in, so small gains are caught early.

• A long-term eating pattern you enjoy. This might be Mediterranean, moderately lower-carb or another balanced approach [10].

• Regular activity, including walking after meals and strength training.

• Yearly HbA1c checks, plus eye, foot and kidney checks, as recommended by the remission consensus [9].

Even if diabetes returns, the time spent in remission is not wasted. In DiRECT, the program group had fewer than half the serious medical events of the usual-care group over 5 years [5].

Frequently asked questions

Which diet is best for type 2 diabetes remission?

The strongest evidence is for structured low-calorie programs of about 800 to 850 calories a day, with 46% to 61% remission at 1 year in trials [3, 6]. Low-carb diets also improve HbA1c, but evidence for medicine-free remission is weaker [8].

Do I need to eat 800 calories a day to reverse diabetes?

No. What matters is losing enough weight to clear fat from the liver and pancreas [2]. Some people do this with low-carb or other diets. An 800-calorie program is simply the fastest, best-tested route.

Can keto put type 2 diabetes into remission?

It can lower HbA1c a lot, but trials show smaller, less certain effects on remission without medicine. Very strict low-carb diets were not better than moderate ones, mainly because people found them hard to stick to [8].

How much weight do I need to lose for remission?

It varies. In DiRECT, 86% of people who lost 15 kg (33 lb) or more were in remission at 1 year [3]. People at a normal weight may need less [2].

Can you get remission if you're not overweight?

Sometimes. In people with a BMI of 21 to 27, stepwise weight loss led to remission in 70% [2]. Talk to your doctor before trying it.

Is an 800-calorie diet safe?

In trials, it was safe for the adults with type 2 diabetes who took part, under medical supervision. In DiRECT, serious adverse events were less common in the program group than with usual care [5]. It is not suitable for everyone, especially people on insulin or with eating disorders.

Take the next step

The Type II Diabetes Remission Strategy shows you how to choose and follow the right remission plan for you, including food reintroduction and long-term maintenance.

Related reading on this site: Getting off metformin safely · Can you eat fruit, bread and rice? · Just diagnosed with type 2 diabetes.

About this article

Written by Dr. Sayantan Banerjee. Last reviewed: October 2026.

This article is for general information and is not medical advice. Do not start a very low-calorie diet or change diabetes medicines without medical supervision.

References

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2. Taylor R. Aetiology of type 2 diabetes: an experimental medicine odyssey. Diabetologia. 2025;68(7):1375-1389. doi:10.1007/s00125-025-06428-0

3. Lean MEJ, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391(10120):541-551. doi:10.1016/S0140-6736(17)33102-1

4. Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7(5):344-355. doi:10.1016/S2213-8587(19)30068-3

5. Lean MEJ, Leslie WS, Barnes AC, et al. 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study. Lancet Diabetes Endocrinol. 2024;12(4):233-246. doi:10.1016/S2213-8587(23)00385-6

6. Taheri S, Zaghloul H, Chagoury O, et al. Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol. 2020;8(6):477-489. doi:10.1016/S2213-8587(20)30117-0

7. Gregg EW, Chen H, Wagenknecht LE, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308(23):2489-2496. doi:10.1001/jama.2012.67929

8. Goldenberg JZ, Day A, Brinkworth GD, et al. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data. BMJ. 2021;372:m4743. doi:10.1136/bmj.m4743

9. Riddle MC, Cefalu WT, Evans PH, et al. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care. 2021;44(10):2438-2444. doi:10.2337/dci21-0034

10. Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med. 2009;151(5):306-314. doi:10.7326/0003-4819-151-5-200909010-00004

11. Guess N, Wane S, Albury C, et al. Testing a New Diabetes Adaptive Weight management Network (NewDAWN): a protocol for a randomised controlled trial. Contemp Clin Trials. 2025;157:108050. doi:10.1016/j.cct.2025.108050