Lifestyle calorie-carbohydrate plans improved type 2 diabetes remission versus usual care

Moderate confidence

some concerns bias

Last updated May 26, 2026

Key takeaway:

In adults with early type 2 diabetes, both calorie-carbohydrate restriction alone and with time-restricted feeding increased remission and improved glycemic and cardiometabolic outcomes versus usual care over 6 months.

Study at a glance

What was studied

Two food-based lifestyle interventions for remission in type 2 diabetes versus usual care.

Study type

Randomized Controlled Trials (RCTs)

duration

Medium-Term (3–12 mo)

Intervention

Calorie restriction, Low-carbohydrate diet

Outcomes

HbA1c, Fasting Plasma Glucose, Body weight, Diabetes remission, Body fat mass

Funding

Non-industry sponsored

Main effects

Diabetes remission increased versus control in both CCR and IFCCR groups

HbA1c and fasting blood glucose were lower in both intervention groups versus control

Body weight, waist circumference, blood pressure, and cardiometabolic markers improved versus control

Evidence Summary

Intervention	Outcome	Measured Change	Study Effect
Calorie restriction (Diet and Nutrition)	Body weight (Weight & Anthropometrics)	Decrease	Strong
Calorie restriction (Diet and Nutrition)	Diabetes remission (Glycemic Control)	Increase	Strong
Calorie restriction (Diet and Nutrition)	Fasting Plasma Glucose (Glycemic Control)	Decrease	Strong
Calorie restriction (Diet and Nutrition)	HbA1c (Glycemic Control)	Decrease	Strong
Low-carbohydrate diet (Diet and Nutrition)	Body fat mass (Weight & Anthropometrics)	Decrease	Strong
Low-carbohydrate diet (Diet and Nutrition)	Body weight (Weight & Anthropometrics)	Decrease	Strong
Low-carbohydrate diet (Diet and Nutrition)	Diabetes remission (Glycemic Control)	Increase	Strong
Low-carbohydrate diet (Diet and Nutrition)	Fasting Plasma Glucose (Glycemic Control)	Decrease	Strong
Low-carbohydrate diet (Diet and Nutrition)	HbA1c (Glycemic Control)	Decrease	Strong

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Evidence Suggest

Remission occurred in 9/40 (22.5%) CCR, 12/40 (30.0%) IFCCR, and 1/40 (2.5%) control participants.
At 6 months, both intervention groups had lower HbA1c and fasting glucose than control (both p<0.001 for each intervention vs control).
Both interventions significantly improved weight, fat mass, lipids, blood pressure, and insulin-resistance indices versus control.

Who this applies to

Adults with type 2 diabetes diagnosed within about 5 years

Keep in Mind

Both active plans outperformed usual care, but IFCCR was not clearly superior to CCR for remission.

Between the Lines

Participants and intervention providers were not blinded due to diet intervention nature.
Control-group remission events were sparse, creating wide confidence intervals.
Follow-up was 6 months, so durability of remission remains uncertain.
Single specialized-center context may limit generalizability to lower-resource settings.

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Journal Reference

Badrooj N, Esteghamati A, Djafarian K, et al. The effect of integrated lifestyle intervention incorporating calorie-carbohydrate restriction with or without time-restricted feeding for remission of type 2 diabetes (DIREM): a single blind randomised controlled trial. Endocrinol Diabetes Metab. 2026;9(3):e70209. doi:10.1002/edm2.70209