Depletion of Liver Fat in Type 2 Diabetes

Prior treatment

• Changes in hypothyroid disease treatment within the last 3 three months prior to enrolment
• Current treatment with anti-obesity medication
• Current treatment with anti-inflammatory medication
• Changes in symptoms or anti-depressive medication three months prior to enrolment
• Diagnosis of psychiatric disorder or treatment with anti-psychotic medication
• History of suicidal behavior or ideations within the last three months prior enrolment
• Previous surgical treatment for obesity (excluding liposuction \> 1 year prior to enrolment)

Other illness

• Diagnosis of Type 1 diabetes, MODY-diabetes, Type 1½ diabetes or LADA-diabetes
• Known or signs of intermediate or severe microvascular complications to diabetes (retino-, neuro- or nephropathy)
• Known cancer
• Lung disease, other than asthma that can be managed with beta2-agonists and does not exhibit seasonal variation
• Known cardiovascular disease
• Known hyperthyroid disease
• Clinical or biochemical signs of hypothyroid disease
• Known liver disease - defined as ALAT or ASAT elevated three times above upper limit
• Known autoimmune disease
• Psoriasis disease requiring systemic treatment or cutan elements bigger than a total area of 25 cm2
• Other endocrine disorder causing obesity
• Biochemical sign of other major diseases

Lab values

• HbA1c ≥ 75 mmol/mol with no glucose lowering medications
• HbA1c ≥ 64 mmol/mol with mono glucose lowering therapy (if compliant with the prescription)
• HbA1c ≥ 57 mmol/mol with ≥ dual glucose lowering therapy (if compliant with the prescription)
• eGFR\<60mL/min (assessed via screening blood sample)
• Treatment with any glucose-lowering medications other than metformin (e.g., insulin (long and/or short acting), sulphonylurea based drugs, glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase 4 inhibitors, sodium-glucose co-transporter-2 inhibitors, thiazolidinediones, alpha-glucosidase inhibitors)

Other

• Presence of metal in the body that would contraindicate an MRI scan
• Weight loss of \> 5kg within the last 6 months
• Pregnant/considering pregnancy, or lactating
• Functional impairments that prevent the performance of intensive exercise
• Participation in other research intervention studies
• Macroalbuminuria at pre-screening (assessed via screening blood sample)
• Presence of circulating glutamatdecarboxylase anti body (GAD) 65 (assessed via screening blood sample)
• Objective findings that contraindicate participation in intensive exercise
• Incidental findings that contraindicate participation in the study
• Unable to allocate the needed time to fulfill the intervention
• Language barrier, mental incapacity, unwillingness, or inability to understand and be able to complete the interventions

• Men and women 30-70 years of age
• The target population is persons with type 2 diabetes. I.e., persons are eligible if they are diagnosed with type 2 diabetes either only with metformin for managing glucose or without use of glucose lowering medications. Persons with a HbA1c ≥ 48 mmol/mol with or without the use of glucose lowering medications are also eligible. Any glucose lowering medications other than metformin are disallowed (described under "Exclusion criteria, below)
• Diabetes duration \< 7 years
• Body Mass Index (BMI) ≥ 30 kg/m2 and ≤ 40 kg/m2
• Accepts medical regulation by the study endocrinologist
• Inactivity, defined as \< 1,5 hours of structured physical activity pr. week at moderate intensity and cycling \< 30 minutes/5 km pr. day at moderate intensity (moderate intensity = out of breath but able to speak)