Background The incidence of diabetes mellitus (DM) has been rising rapidly, the regulation of lifestyle is essential for adjuvant treatment of DM. According to the theory of traditional Chinese medicine (TCM), the patients diagnosed with “Xiaoke” (consumptive thirst), which perfectly matches the symptoms of DM, should follow strict dietary management, namely low intake and high frequency with a low-fat diet. Objective The purpose of this study is to assess the effect of TCM theory-guided dietary management combined with exercise interventions for type 2 diabetes (T2DM). Methods 30 patients with T2DM were assigned to receive dietary management combined with exercise interventions (over 3 months). The primary outcome was the change from baseline to month 3 in the level of hemoglobin A1c (HbA1c). Secondary outcomes included the changes from baseline in the levels of fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL). Results Among the 30 participants (mean age 62.4 ±8.7 years), 25 completed the study. Mean level of HbA1c at baseline was 8.3% ± 1.9% for patients with type 2 diabetes. At the third month, dietary management combined with exercise interventions had significant decrease in mean HbA1c (6.9% ± 1.5%) with a mean difference of 1.4 ± 1.5% (P < 0.0001). The changes from baseline were significant with differences, including 1.4 ± 2.7 mmol/L of FBG (P = 0.0189), 0.6 ± 0.7 mmol/L of TC (P = 0.0004), and 0.2 ± 0.4 mmol/L of LDL (P = 0.0083). The incidence of treatment-related adverse events was 8% and all events were classified as mild. Conclusions Moderate-intensity (4?5 MET) aerobic resistance training combined with individualized nutritional therapy for 3 months can reduce HbA1c by approximately 1.4% in patients with T2DM. The provision of this lifestyle intervention could allow individuals with T2DM to achieve improvements in dyslipidemia, with potential long-term benefits for diabetes-related complications and wellbeing. Due to small samples in this pilot study, further research is needed to see whether this intervention will match results of this pilot study.