Study links prediabetes remission to lower diabetes risk without weight loss
Researchers in Tübingen have found that people with prediabetes can reduce their risk of developing type 2 diabetes by 71% through lifestyle changes that normalize blood sugar levels, even if they do not lose weight. The study emphasizes the role of improved fat distribution over mere weight reduction. This challenges current guidelines focused primarily on shedding pounds.
Prediabetes affects an estimated one in ten adults worldwide, with many cases undetected due to lack of symptoms. It involves elevated blood sugar levels that increase the risk of type 2 diabetes, a condition impacting over 460 million people globally and linked to complications like cardiovascular disease and cancer.
In a long-term study by the University Hospital of Tübingen, involving over 1,100 participants, researchers from Helmholtz Munich and the German Center for Diabetes Research (DZD) tracked outcomes for up to 10 years. Of these, 234 individuals underwent lifestyle interventions—such as a healthy diet and increased physical activity—but either maintained or gained weight over one year. Remarkably, 22% of this group normalized their blood sugar levels. Over the follow-up period, these individuals were 71% less likely to develop type 2 diabetes, a reduction nearly identical to the 73% seen in those who lost weight.
The key insight was fat distribution. Participants who achieved normal blood sugar without weight loss showed a reduced percentage of visceral fat—the harmful abdominal fat surrounding organs that promotes inflammation and insulin resistance—compared to those whose levels remained elevated.
"Restoring a normal fasting blood sugar level is the most important goal in preventing type 2 diabetes and not necessarily the number on the scale," said Prof. Dr. Andreas Birkenfeld, study leader and director of the Institute for Diabetes Research and Metabolic Diseases at Helmholtz Munich and the University of Tübingen. He added, "Exercise and a balanced diet have a positive effect on blood sugar levels, regardless of whether weight is reduced. Losing weight remains helpful, but our data suggests that it is not essential for protection against diabetes."
Prof. Dr. Reiner Jumpertz-von Schwartzenberg, the study's last author, noted, "In future, guidelines for the prevention and treatment of type 2 diabetes should not only take weight into account, but above all blood glucose control and fat distribution patterns."
The findings, published in Nature Medicine in 2025, suggest broadening prevention strategies to prioritize glycemic control alongside weight management, highlighting lifestyle changes as a pathway to prediabetes remission independent of scale readings.