This study is a real-world, prospective clinical cohort study. It will enroll Chinese patients with type 2 diabetes. The aim is to assess the changes in aging biomarkers, primarily DunedinPACE, from baseline to post-remission, and to compare these biomarkers between patients who achieve successful remission and those who do not.
Age 35 to 70 years.
Diagnosis of type 2 diabetes mellitus according to WHO criteria, with disease duration ≤6 years.
HbA1c between 7.0% and 9.5%, OR currently on glucose-lowering medications.
Fasting C-peptide ≥1.0 ng/mL.
Diabetes mellitus secondary to other causes (e.g., Cushing's syndrome, hypothyroidism, glucagonoma, drug-induced, or genetic factors).
BMI <25 kg/m² or >45 kg/m²; weight loss >5% within the last 3 months; actively trying to lose weight within the last 3 months; use of weight-loss agents, contraceptives, glucocorticoids, or any medication other than antidiabetic drugs that may affect study outcome measurements within the last 3 months; history of bariatric surgery.
Type 1 diabetes; type 2 diabetes duration >10 years; gestational diabetes; other specific types of diabetes.
Diagnosis of acute metabolic diabetic complications (e.g., diabetic ketoacidosis or hyperosmolar hyperglycemic state) or diabetes insipidus within 30 days, or history thereof.
Single group
Comprehensive Lifestyle Intervention
Other interventionParticipants will receive a 24-week comprehensive lifestyle intervention： 1. Individualized calorie-restricted low-carbohydrate diet: 800-1000 kcal/day if body weight \<80 kg, or 1000-1200 kcal/day if ≥80 kg; each meal includes \~200 g vegetables and \~100 g lean protein, with low fat/sugar/salt; avoid high-fat meats and organ foods; daily food weighing and recording required. 2. Aerobic exercise ≥150 min/week at moderate intensity (50-70% of maximal heart rate) plus 2-3 resistance training sessions weekly. 3. Monthly nutrition clinic visits for dietary adjustment. 4. Self-monitoring of weight and fasting glucose ≥2 times/week; monthly in-person follow-ups for the first 6 months. 5. Hypoglycemic agents: baseline doses maintained; if fasting glucose \<7 mmol/L and 2-h postprandial glucose \<10 mmol/L, reduce 1-2 drug types per step; hypoglycemia episodes managed by investigator for dose reduction or discontinuation.
Change in DunedinPACE epigenetic clock from baseline to 24 weeks.
DunedinPACE is derived from Illumina Epic DNA methylation data. The change score is compared between participants with and without diabetes remission (remission defined as HbA1c \<6.5% off glucose-lowering drugs for ≥3 months).
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