Individuals with prediabetes may be able to return to normal glucose regulation even without losing weight, according to a study published in Nature Medicine. The findings could reshape strategies for preventing type 2 diabetes.
Traditionally, remission of prediabetes, defined as a return to normal blood glucose levels, has been closely linked to weight loss. However, researchers analyzing data from the Prediabetes Lifestyle Intervention Study (PLIS) found that remission can also occur independently of weight change. The German trial, conducted between 2012 and 2016, followed over 1,100 adults with prediabetes. Among the 234 participants who did not lose weight over 12 months, 51 achieved remission. These individuals displayed healthier fat distribution, improved insulin sensitivity, and better beta-cell function compared with non-responders.
Responders tended to store fat under the skin rather than around internal organs, a pattern associated with better metabolic health. This shift, along with increased insulin secretion and beta-cell responsiveness, appeared to protect against type 2 diabetes despite stable or slightly increased weight. Long-term follow-up indicated that remission without weight loss lowered diabetes risk by about 71 percent, a benefit similar to remission achieved through weight reduction. The results were confirmed in the United States Diabetes Prevention Program, strengthening the study’s conclusions.
Supporting this research, a study by Syeda and colleagues demonstrated that improvements in physical activity and dietary quality can enhance glucose control and promote remission of prediabetes even without significant weight loss. Exercise boosts insulin sensitivity and beta-cell function independently of body weight changes. These findings suggest that metabolic health, fat distribution, and glucose regulation may be more important than weight alone in preventing type 2 diabetes. Experts recommend that waist circumference, visceral fat markers, and insulin function be considered alongside weight in clinical prevention strategies.
This study challenges the conventional focus on weight loss as the primary goal in prediabetes management. Restoring normal glucose regulation through improved metabolic health and lifestyle interventions can effectively reduce diabetes risk, even without losing weight.
References
- Sandforth, A., Arreola, E.V., Hanson, R.L. et al. Prevention of type 2 diabetes through prediabetes remission without weight loss. Nat Med (2025). https://doi.org/10.1038/s41591-025-03944-9
- Syeda USA, Battillo D, Visaria A, Malin SK. The importance of exercise for glycemic control in type 2 diabetes. American Journal of Medicine Open. 2023 June 1;9:100031.