Reducing risk for diabetes is possible, even without weight loss, according to new study
If you’ve ever known someone with pre-diabetes, they may have been told that weight loss will lower their blood sugar. While research still supports this advice, a recent study suggests that lifestyle and diet changes alone may move the needle. 1, 2
A large study from Tübingen, Germany, finds that people who reduce their blood sugar to a healthy level through lifestyle changes - without weight loss, and even in some situations, weight gain -can still cut their risk of developing type 2 diabetes by 71 percent. The research was done by experts from the University Hospital of Tübingen, Helmholtz Munich, and the German Center for Diabetes Research (DZD).
Globally, prediabetes impacts millions of people. Roughly one out of ten adults is estimated to have prediabetes, though this number is likely higher because of undiagnosed cases. Prediabetes happens when blood sugar levels increase above the normal range, but aren’t yet considered high enough for a diagnosis of diabetes.
Initially, prediabetes has no symptoms. But as the body’s cells become resistant to insulin, less sugar (from food) travels from the bloodstream into cells, resulting in blood sugar levels rising. If left untreated, prediabetes can lead to type 2 diabetes, which affects over 460 million people worldwide, and raises the risk of serious chronic diseases like heart disease and certain cancers.
Normal Blood Sugar is Key
The majority of diabetes prevention programs and clinical guidelines have focused on weight reduction through a healthy diet and regular exercise. New research suggests this method could be improved upon beyond the focus on body weight.
In a recent, long-term study of over 1,100 subjects, researchers followed blood sugar trends. Within these participants, 234 people maintained weight or gained weight in the first year, despite lifestyle changes. Roughly 22% of these subjects were able to improve their blood sugar to normal ranges.
After an additional follow-up period of up to nine years, individuals who regulated their blood sugar without weight loss had a 71% lower risk of developing type 2 diabetes. This impact was almost as beneficial as the subjects who had lost weight (73% risk reduction).
Why Fat Distribution Matters
Scientists took a hard look at fat distribution in the body. They examined visceral fat (the fat packed around organs in the abdomen) with subcutaneous fat (the fat right under the skin). Inflammation and altered hormonal balance are triggered by signaling molecules made from visceral fat. This can result in insulin resistance, leading to the risk of diabetes.
Subjects who lost abdominal fat normalized their blood sugar, which suggests that fat distribution may make a difference in the progression to type 2 diabetes.
Beyond the Scale
Prof. Dr. Andreas Birkenfeld, study leader and director of the Institute for Diabetes Research and Metabolic Diseases (IDM) of Helmholtz Munich at the University of Tübingen noted, "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. 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," he continues.
Prof. Dr. Reiner Jumpertz-von Schwartzenberg, one of the authors involved in the study, stated, "In the 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”.
Lifestyle Habits Make a Difference
The results of this study highlight the importance of focusing on healthy blood sugar levels (glycemic targets) and weight-related goals in preventing diabetes. Reaching prediabetes remission is one of the best ways to avoid progressing to type 2 diabetes, and this may happen without losing weight. Maintaining regular exercise and a balanced diet is still needed to maintain blood sugar levels in a healthy range.
Below are tips to reduce visceral fat and manage blood sugar levels.
· Avoid or limit alcohol intake. Heavy drinking or binge drinking has been linked with increased visceral fat accumulation. 3
· Reduce added sugars. In addition to empty calories, excess added sugar raises blood sugar. 4
· Choose whole grains over refined grains for more fiber, vitamins, minerals, and antioxidants.
· Reduce or avoid processed meats. Hot dogs, meat sticks, and sausage have been associated with an increased risk for diabetes. 5
· Limit red meat intake. Higher intakes of red meat are linked with higher rates of diabetes. 6
· Cut out sweetened beverages. Soda, sports drinks, and sweetened teas may contribute to unwanted weight gain and risk for diabetes. 7
· Consider a more plant-based diet, which may reduce your risk of diabetes. 8
· Walk regularly. Research suggests this is one of the best exercises to reverse type 2 diabetes. 9
· Walk for 15 minutes, 45 minutes after your meal. This is when blood sugar peaks. This practice alone can reduce your blood sugar. 10
· Include strength training in your exercise routine. This improves muscle mass, which may lower your HbA1c. 11.
Lisa Andrews, MEd, RD, LD
References:
Echouffo-Tcheugui JB, Perreault L, Ji L, Dagogo-Jack S. Diagnosis and Management of Prediabetes: A Review. JAMA. 2023 Apr 11;329(14):1206-1216. doi: 10.1001/jama.2023.4063. PMID: 37039787.
Arvid Sandforth, Elsa Vazquez Arreola, Robert L. Hanson, Nicolai J. Wewer Albrechtsen, Jens Juul Holst, Robert Ahrends, Cristina Coman, Felicia Gerst, Estela Lorza-Gil, Yurong Cheng, Leontine Sandforth, Sarah Katzenstein, Marlene Ganslmeier, Jochen Seissler, Hans Hauner, Nikolaos Perakakis, Robert Wagner, Jürgen Machann, Fritz Schick, Andreas Peter, Rainer Lehmann, Cora Weigert, Jennifer Maurer, Hubert Preissl, Martin Heni, Julia Szendrödi, Stefan Kopf, Michele Solimena, Peter Schwarz, Matthias Blüher, Hans-Ulrich Häring, Martin Hrabé de Angelis, Annette Schürmann, Stefan Kabisch, Knut Mai, Andreas F. H. Pfeiffer, Stefan Bornstein, Michael Stumvoll, Michael Roden, Norbert Stefan, Andreas Fritsche, Andreas L. Birkenfeld, Reiner Jumpertz von Schwartzenberg. Prevention of type 2 diabetes through prediabetes remission without weight loss. Nature Medicine, 2025; DOI: 10.1038/s41591-025-03944-9
Kazibwe R, Chevli PA, Evans JK, Allison M, Michos ED, Wood AC, Ding J, Shapiro MD, Mongraw-Chaffin M. Association Between Alcohol Consumption and Ectopic Fat in the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2023 Sep 19;12(18):e030470. doi: 10.1161/JAHA.123.030470. Epub 2023 Sep 8. PMID: 37681576; PMCID: PMC10547290.
Gillespie KM, Kemps E, White MJ, Bartlett SE. The Impact of Free Sugar on Human Health-A Narrative Review. Nutrients. 2023 Feb 10;15(4):889. doi: 10.3390/nu15040889. PMID: 36839247; PMCID: PMC9966020.
Hill ER, O'Connor LE, Wang Y, Clark CM, McGowan BS, Forman MR, Campbell WW. Red and processed meat intakes and cardiovascular disease and type 2 diabetes mellitus: An umbrella systematic review and assessment of causal relations using Bradford Hill's criteria. Crit Rev Food Sci Nutr. 2024;64(9):2423-2440. doi: 10.1080/10408398.2022.2123778. Epub 2022 Sep 26. PMID: 36154543.
6. Li C, Bishop TRP, Imamura F, Sharp SJ, Pearce M, Brage S, Ong KK, Ahsan H, Bes-Rastrollo M, Beulens JWJ, den Braver N, Byberg L, Canhada S, Chen Z, Chung HF, Cortés-Valencia A, Djousse L, Drouin-Chartier JP, Du H, Du S, Duncan BB, Gaziano JM, Gordon-Larsen P, Goto A, Haghighatdoost F, Härkänen T, Hashemian M, Hu FB, Ittermann T, Järvinen R, Kakkoura MG, Neelakantan N, Knekt P, Lajous M, Li Y, Magliano DJ, Malekzadeh R, Le Marchand L, Marques-Vidal P, Martinez-Gonzalez MA, Maskarinec G, Mishra GD, Mohammadifard N, O'Donoghue G, O'Gorman D, Popkin B, Poustchi H, Sarrafzadegan N, Sawada N, Schmidt MI, Shaw JE, Soedamah-Muthu S, Stern D, Tong L, van Dam RM, Völzke H, Willett WC, Wolk A, Yu C; EPIC-InterAct Consortium; Forouhi NG, Wareham NJ. Meat consumption and incident type 2 diabetes: an individual-participant federated meta-analysis of 1·97 million adults with 100 000 incident cases from 31 cohorts in 20 countries. Lancet Diabetes Endocrinol. 2024 Sep;12(9):619-630. doi: 10.1016/S2213-8587(24)00179-7. Erratum in: Lancet Diabetes Endocrinol. 2025 Feb;13(2):e2. doi: 10.1016/S2213-8587(25)00002-6. PMID: 39174161.
Lara-Castor L, O'Hearn M, Cudhea F, Miller V, Shi P, Zhang J, Sharib JR, Cash SB, Barquera S, Micha R, Mozaffarian D; Global Dietary Database. Burdens of type 2 diabetes and cardiovascular disease attributable to sugar-sweetened beverages in 184 countries. Nat Med. 2025 Feb;31(2):552-564. doi: 10.1038/s41591-024-03345-4. Epub 2025 Jan 6. Erratum in: Nat Med. 2025 Feb;31(2):696. doi: 10.1038/s41591-025-03524-x. PMID: 39762424; PMCID: PMC11835746.
Wang Y, Liu B, Han H, Hu Y, Zhu L, Rimm EB, Hu FB, Sun Q. Associations between plant-based dietary patterns and risks of type 2 diabetes, cardiovascular disease, cancer, and mortality - a systematic review and meta-analysis. Nutr J. 2023 Oct 4;22(1):46. doi: 10.1186/s12937-023-00877-2. Erratum in: Nutr J. 2024 Jan 4;23(1):6. doi: 10.1186/s12937-023-00891-4. PMID: 37789346; PMCID: PMC10548756.
Zhang Y, Yang Y, Huang Q, Zhang Q, Li M, Wu Y. The effectiveness of lifestyle interventions for diabetes remission on patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Worldviews Evid Based Nurs. 2023 Feb;20(1):64-78. doi: 10.1111/wvn.12608. Epub 2022 Dec 8. PMID: 36480153.
https://scienceinsights.org/is-it-good-to-walk-after-eating-what-science-says/
Kobayashi Y, Long J, Dan S, Johannsen NM, Talamoa R, Raghuram S, Chung S, Kent K, Basina M, Lamendola C, Haddad F, Leonard MB, Church TS, Palaniappan L. Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes: a randomised controlled trial. Diabetologia. 2023 Oct;66(10):1897-1907. doi: 10.1007/s00125-023-05958-9. Epub 2023 Jul 26. Erratum in: Diabetologia. 2024 Aug;67(8):1725-1726. doi: 10.1007/s00125-024-06135-2. PMID: 37493759; PMCID: PMC10527535.