Study Shows that Normalizing Blood Sugar Levels Reduces Diabetes Risk Independent of Weight Loss

Recent findings from a large study led by researchers from the University Hospital Tübingen reveal that people with prediabetes can protect themselves from progressing to type 2 diabetes by returning their blood sugar levels to normal, even if they do not lose weight or experience weight gain. Prediabetes affects millions globally, often goes undetected, and is marked by blood sugar values that are elevated but do not reach diabetic thresholds. 

Traditionally, type 2 diabetes prevention guidelines for people with prediabetes have centered on achieving weight reduction through healthy eating and increased physical activity. The new analysis suggests broadening this focus. In the Tübingen research, published in Nature Medicine, over 1,100 participants made lifestyle changes over one year but 234 of them did not lose weight and some even gained weight. Still, 22 percent of this group achieved normalization of blood sugar. The follow-up, spanning up to nine years, demonstrated that individuals who normalized blood sugar without weight loss reduced their chance of developing diabetes by 71 percent—almost identical to the 73 percent reduced risk observed in those who lost weight. 

The study placed special emphasis on where fat was distributed in the body, especially comparing visceral fat (around organs) to subcutaneous fat (under the skin). Visceral fat secretes factors that disrupt hormones and stimulate inflammation, directly contributing to insulin resistance and type 2 diabetes. Participants who normalized their blood sugar did so with a decrease in abdominal fat, regardless of overall weight change.

According to study leader Prof. Dr. Andreas Birkenfeld, “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.”

The results underscore the value of including target blood sugar levels in diabetes prevention strategies, confirming that remission of prediabetes is the most effective way to prevent type 2 diabetes, often independent of weight loss.