Aims: As type 2 diabetes (T2D) continues to rise globally and remains a major driver of cardiovascular disease, its remission has emerged as a therapeutic target. Current evidence supports bariatric surgery and low-calorie diets with meal replacements. No clinical trial to date has evaluated plant-based dietary alternatives as an intensive lifestyle intervention (ILI) strategy, despite the emphasis on plant-based diets in current clinical practice guidelines for diabetes and cardiovascular disease. The REmission of diabetes using a PlAnt-based weight loss InteRvention (REPAIR) trial will assess whether a 52-week plant-based ILI targeting ≥15% weight loss is effective for diabetes remission in a multi-ethnic Canadian population.
Materials and methods: The REPAIR trial is a prospective, randomised, 2-arm, open-label, blinded-endpoint efficacy trial. Participants will include 160 adults with early T2D (<6 years) and living with obesity. They will be randomised to standard of care or a 2-phase ILI targeting ≥15% weight loss consisting of a 12-week weight loss phase on a plant-based total diet meal replacement, followed by a 40-week weight loss maintenance phase on a plant-based dietary pattern combined with a 16-week structured exercise program, and a 52-week (19-session) sustainable behaviour change curriculum. The primary outcome is diabetes remission (HbA1c <6.5% without glucose-lowering medication for ≥3 months) and the key secondary outcome is the proportion achieving ≥15% weight loss at 52 weeks.
Conclusions: This trial will provide high-quality clinical evidence on the use of plant-based ILIs to address the epidemics of obesity and diabetes to inform public health policies and programs in Canada and beyond.
Keywords: clinical trial; dietary intervention; exercise intervention; plant‐based; type 2 diabetes; weight management.
© 2026 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.