Lifestyle calorie-carbohydrate plans improved type 2 diabetes remission versus usual care
Last updated May 26, 2026
Key finding
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.
This randomized trial compared two structured food-based lifestyle programs against usual care in type 2 diabetes. Both active programs improved remission, HbA1c, fasting glucose, weight, blood pressure, and lipid markers at 3 and 6 months. Intermittent fasting plus calorie-carbohydrate restriction showed numerically higher remission and greater fat-mass loss, but remission differences versus calorie-carbohydrate restriction alone were not statistically clear.
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Study at a glance
The essential study design details in one scan.
EvidenceScore™
Moderate
Study type
Randomized Controlled Trials (RCTs)
Follow-up
Medium-Term (3–12 mo)
Risk of bias
Some Concerns
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Plain-language summary
What this paper says
A plain-language read of the study’s main message and where it applies.
Study focus
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.
Published in
Journal Reference
Publication details and source links for this paper.
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
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 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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