Reversing Prediabetes Dramatically Cuts Diabetes Risk

What Did the Research Discover?

This study investigated whether lifestyle interventions (LI) for preventing type 2 diabetes are equally effective for all individuals with prediabetes or if different approaches are needed based on individual risk levels. The researchers categorized participants into low-risk (LR) and high-risk (HR) phenotypes based on factors such as insulin secretion, insulin sensitivity, and liver fat content. They then tested whether HR individuals benefit more from an intensified LI while LR individuals respond well to conventional LI.

The study followed 1,105 individuals with prediabetes for 12 months and continued monitoring them for two additional years. Participants were randomly assigned to different intervention groups:

• LR individuals received either a conventional LI (similar to the Diabetes Prevention Program, DPP) or were placed in a control group that did not receive LI.
• HR individuals received either a conventional LI or an intensified LI that required twice the amount of weekly exercise and additional coaching sessions.

After one year, the HR group that received intensified LI showed greater reductions in post-meal blood glucose levels, liver fat content, and cardiovascular risk compared to those who received conventional LI. Specifically:

• Post-meal blood sugar levels dropped significantly more in the intensified LI group (-0.29 mmol/L).
• Liver fat content decreased by 1.34 percentage points, an important marker for metabolic health.
• Cardiovascular risk declined significantly, suggesting broader health benefits beyond diabetes prevention.

In contrast, among the LR individuals, conventional LI did not result in significant changes in glucose metabolism compared to the control group. This suggests that not all individuals with prediabetes may need intensive intervention to prevent diabetes, and some may not require any intervention at all.

Over a total follow-up of three years, HR individuals who received intensified LI were significantly more likely to return to normal glucose levels than those receiving conventional LI, reinforcing the idea that higher-risk individuals need more aggressive lifestyle modifications to reverse prediabetes.

How Can I Apply This Information?

For individuals with prediabetes, this study highlights the importance of personalized lifestyle interventions. Those at higher risk—characterized by insulin resistance, poor insulin secretion, and higher liver fat levels—should consider more intensive lifestyle changes. This includes increasing physical activity to at least six hours per week, improving diet quality, and maintaining regular monitoring of metabolic health markers. For individuals at lower risk, simply making moderate lifestyle adjustments may be sufficient, and in some cases, intervention may not be necessary.

For healthcare providers, this research suggests that a one-size-fits-all approach to diabetes prevention may not be ideal. Risk stratification based on insulin sensitivity, secretion, and liver fat content could help determine whether a patient requires conventional or intensified intervention. Healthcare teams should consider offering higher-risk patients more frequent coaching sessions, structured exercise programs, and targeted dietary interventions, while low-risk individuals may benefit from routine monitoring and general lifestyle guidance rather than intensive programs.

For public health and policy makers, the study supports a more efficient allocation of healthcare resources by focusing intensive diabetes prevention programs on those most at risk. Given that not all individuals with prediabetes will develop diabetes, screening and targeted interventions can prevent unnecessary treatment for low-risk individuals while ensuring that high-risk individuals receive the support they need. Workplace wellness programs, insurance coverage for personalized LI, and broader implementation of structured diabetes prevention programs tailored to risk phenotypes could be effective strategies.

The findings of this study emphasize that diabetes prevention efforts should not be generalized but rather tailored to individual metabolic risks. By identifying who truly needs intervention and what type of intervention is most effective, healthcare systems can improve outcomes while optimizing resources.

Source:

Fritsche A, Wagner R, Heni M, Kantartzis K, Machann J, Schick F, Lehmann R, Peter A, Dannecker C, Fritsche L, Valenta V. Different effects of lifestyle intervention in high-and low-risk prediabetes: results of the randomized controlled prediabetes lifestyle intervention study (PLIS). Diabetes. 2021 Dec 1;70(12):2785-95. https://pubmed.ncbi.nlm.nih.gov/34531293/