Prediabetes remission could become a central goal of diabetes prevention

Type 2 diabetes typically emerges gradually over decades, but preventive efforts often commence only when blood glucose levels are already abnormal. An international team of experts, including researchers from University Hospital Tübingen and the German Center for Diabetes Research (DZD), is advocating for a radical transformation in the way diabetes prevention is approached.

In a paper published in Nature Medicine, they outline a comprehensive 10-point framework aimed at preventing both type 2 diabetes and its complications.

Prof. Andreas L. Birkenfeld, a prominent figure in the study and head of the Diabetology Department at University Hospital Tübingen, emphasizes that type 2 diabetes rarely develops abruptly. Instead, the risk for the condition often accumulates over many years, influenced by a complex interplay of biological, social, and behavioral factors at various stages of life. The researchers argue that effective prevention must therefore start far earlier and consider individual risk factors throughout the entire life course.

The panel of experts proposes a "life-course approach," treating diabetes prevention not as a one-time intervention in adulthood, but as an ongoing process that spans from pre-pregnancy to older adulthood. Six critical life stages are identified as particularly important: the period before pregnancy, pregnancy, early childhood, adolescence and young adulthood, and midlife.

Traditionally, much of the focus on diabetes prevention has centered on diet and exercise in adulthood. However, the researchers stress that the risk of the disease later in life is largely determined by factors that occur much earlier. The health of a mother and father prior to conception can significantly impact the metabolic well-being of their offspring. Pregnancy and breastfeeding also present valuable opportunities to positively influence the health of both generations.

Central to the paper is the concept of "remission," particularly in the context of prediabetes—a condition where blood glucose levels are elevated but not yet at the threshold for a diabetes diagnosis. Studies have shown that targeted lifestyle changes can often restore normal blood sugar regulation during the prediabetes stage, substantially reducing the long-term risk of developing type 2 diabetes.

According to Prof. Birkenfeld, prediabetes remission—the restoration of normal blood glucose levels—should become a core objective of prevention efforts, not merely a secondary goal. The ultimate aim is to restore metabolic health as early and as sustainably as possible, rather than simply halting the progression of the disease.

Beyond synthesizing the current state of knowledge on diabetes prevention, the international panel of experts lays out the first consensus-driven 10-point framework for the future direction of the field. This framework identifies key priorities, including early risk assessment, personalized and digital tools, and efforts to reduce health inequities.

The authors' framework represents the first international agreement on the most critical steps needed to make diabetes prevention more effective. By identifying risks earlier, establishing prediabetes remission as a central prevention target, and promoting long-term metabolic health, the researchers hope to shift the paradigm of diabetes prevention and ultimately reduce the burden of this chronic condition.