New research published in Nature Medicine reveals that people with prediabetes can normalize blood sugar levels without losing weight. About one in four participants in lifestyle programs achieved this remission, offering protection against diabetes similar to weight loss methods. The key factors involve fat distribution and certain hormones.
For decades, advice for those with prediabetes—a condition affecting up to one in three adults, depending on age—has centered on weight loss to prevent diabetes. Yet diabetes rates continue to rise globally, and many struggle to meet weight targets. A study challenges this by showing prediabetes remission without weight reduction is feasible and equally protective against type 2 diabetes. In the research, published in Nature Medicine (2025; 31(10):3330, DOI: 10.1038/s41591-025-03944-9), approximately one in four individuals in lifestyle interventions normalized blood sugar without shedding pounds, and sometimes even with weight gain. The explanation lies in fat storage. Visceral fat, deep in the abdomen around organs, drives inflammation and impairs insulin function, raising blood glucose. Subcutaneous fat under the skin, however, aids metabolism by releasing supportive hormones. Participants achieving remission shifted fat from visceral to subcutaneous areas. Hormones also play a role, particularly GLP-1-like ones, which enhance insulin release from pancreatic beta cells when glucose rises. Those in remission boosted these naturally while curbing glucose-raising hormones—similar to effects from drugs like Wegovy and Mounjaro. Practical steps include diets rich in polyunsaturated fatty acids, such as Mediterranean-style with fish oil, olives, and nuts, which reduce visceral fat. Endurance exercise similarly targets abdominal fat without necessitating overall weight drop. While weight loss remains beneficial for health, the study urges prioritizing blood sugar normalization and metabolic shifts. Authors from University of Tübingen, including Andreas L. Birkenfeld and Reiner Jumpertz-von Schwartzenberg, suggest doctors track these changes for patients facing weight loss difficulties. This approach could broaden diabetes prevention worldwide.
