Improving cognition through lifestyle-induced remission of type 2 diabetes: findings from DIABEPIC-2

Cognitive deficits are common but underrecognized complications of type 2 diabetes (T2D), which may be mitigated by lifestyle factors. The DIABEPIC-2 pilot trial evaluated a 6-month lifestyle intervention targeting T2D remission. We aimed to assess post-intervention changes in cognitive performance and identify associations with metabolic, anthropometric and intervention-related parameters.

. This secondary analysis included thirty adults with T2D (mean age 63.0 years, 60% male) who completed neuropsychological testing before and after an intervention combining nutritional counseling and supervised exercise. Cognitive outcomes were analyzed using repeated-measures ANOVAs, and indicators were calculated to identify clinically meaningful changes. Associations with hemoglobin A1c (HbA1c), relative fat mass (RFM), exercise dose, dietary adherence and remission status were examined using multivariable or logistic regression models.

Significant improvements were observed in global cognition (p = 0.03), verbal memory (p = 0.008), and executive function (p = 0.005). Clinically meaningful memory improvements occurred in 20% of participants. Reductions in HbA1c and RFM, as well as higher exercise dose, were independently associated with greater memory gains, whereas dietary adherence and remission status were not.

. A lifestyle intervention for T2D remission was associated with improvements in global cognition and executive function, as well as clinically meaningful gains in verbal memory. These benefits appear primarily driven by improvements in glycemic control, body composition, and exercise engagement rather than remission itself. Larger controlled trials are warranted to confirm these findings and document long-term cognitive effects.