In an article published in the journal Nature Reviews Endocrinology, they argue that persistent prediabetes may be associated with an increased risk of certain types of cancer, while remission may counteract this risk.
Many types of cancer are linked to preventable risk factors such as smoking, alcohol consumption, overweight, or a lack of exercise. According to Birkenfeld and Heikenwälder, many of these factors ultimately exert their effects through shared physiological changes. These include elevated blood sugar values, insulin resistance, chronic inflammatory processes, and hormonal changes. Together, they impact on biological processes involved in the development of cancer.
Against this backdrop, the scientists are calling for a shift in perspective: rather than focusing solely on individual risk factors, maintaining metabolic health—or restoring it when it has become impaired—could itself become an important approach to cancer prevention.
Concept of Prediabetes Remission
The concept of prediabetes remission has been established in the DZD. It describes an intervention-induced state in which a person with prediabetes returns to normoglycaemic glucose levels, for example after a lifestyle intervention. It reflects a targeted shift toward improved insulin sensitivity, β-cell function, and inflammation.
Large population studies show a link
This potential role of metabolic restoration in cancer prevention is supported by large population-based studies from South Korea. In a cohort of more than six million people who had neither diabetes nor cancer at baseline, researchers investigated how changes in blood glucose levels were associated with subsequent pancreatic cancer risk.They found that people with persistent prediabetes had a higher risk of pancreatic cancer than those with consistently normal blood sugar values (HR 1.02, 95% CI 0.96–1.10). In contrast, individuals whose blood sugar values returned to normal no longer showed a statistically significant increased risk.
A similar picture emerged for gallbladder cancer. Here, too, persistent prediabetes was associated with an increased risk of disease, while no significant increase in risk was observed among people in remission (HR 1.03, 95% CI 0.88–1.21).
However, the authors emphasize that these findings do not yet constitute causal evidence that prediabetes remission prevents cancer. Rather, they provide epidemiological evidence of a possible link, which must now be examined in further studies.
Remission is not a rare occurrence
The authors find it particularly interesting that a return to normoglycemia is far from exceptional. In the cohorts analyzed, more people achieved prediabetes remission than remained in a prediabetic metabolic state. “This suggests that prediabetes remission is not just be a theoretical concept, but a realistic goal for population-wide prevention strategies,” says Birkenfeld.
More than just a matter of body weight
The authors also point out that body mass index (BMI) alone often provides insufficient information about a person’s actual metabolic risk. People with similar body weights can differ significantly in terms of insulin sensitivity, fat distribution, and inflammatory activity.
“For this reason, normalizing glucose metabolism may be a more precise goal than focusing solely on weight loss,” says Heikenwälder. According to the authors, prediabetes remission should therefore be considered as a complementary marker of the success of preventive measures.
Conclusion: A new direction for preventive medicine
Birkenfeld and Heikenwälder view prediabetes remission as a potential component of “physiology-based prevention,” in which restoring a healthy metabolism in the early stages plays a key role. The focus is no longer solely on avoiding individual risk factors, but rather on the targeted improvement of biological states that can impact multiple diseases simultaneously.
However, it has not yet been conclusively determined whether prediabetes remission plays a causal role in reducing the risk of cancer. The authors therefore view their work as a catalyst for further research. In their opinion, the available data support a biologically plausible and epidemiologically grounded hypothesis that should be tested in future prospective studies.
Original publication:
Birkenfeld AL, Heikenwälder M. Cancer prevention through metabolic remission. Nature Reviews Endocrinology (2026). DOI: 10.1038/s41574-026-01268-3.
Scientific contact:
Prof. Dr. Andreas L. Birkenfeld
University Hospital Tübingen
Otfried-Müller-Straße 10
72076 Tübingen
E-Mail: andreas.birkenfeld@med.uni-tuebingen.de
Phone: +49 7071 29-82735
The German Center for Diabetes Research (DZD e.V.) is one of the eight German Centers for Health Research. It brings together experts in the field of diabetes research and combines basic research, epidemiology and clinical application. The aim of the DZD is to make a significant contribution to the successful, customized prevention, diagnosis and treatment of diabetes mellitus through a novel, integrative research approach. www.dzd-ev.de/en
Founded in 1805, Tübingen University Hospital is one of the leading centers of university medicine in Germany. Being one of the 33 university hospitals in Germany, it contributes to the successful combination of high-performance medicine, research and teaching. More than 400,000 inpatients and outpatients from all over the world benefit from this combination of science and practice every year. The clinics, institutes and centers bring together specialists from a wide range of disciplines under one roof.
The experts work together on an interdisciplinary basis and offer each patient the best possible treatment based on the latest research findings. The University Hospital of Tübingen is researching for better diagnoses, therapies and chances of recovery. Many new treatment methods are being clinically tested and applied here. In addition to diabetology, research in Tübingen focuses on neurosciences, oncology, immunology, infection research and vascular medicine. Over the past 25 years, the Chair of Diabetology / Endocrinology has been a center of interdisciplinary research, particularly involving surgery, radiology and laboratory medicine. www.medizin.uni-tuebingen.de/en-de
