Lifestyle Changes May Not Always Reduce Elevated Blood Glucose Levels

In the “Prediabetes Lifestyle Intervention Study (PLIS)” of the German Center for Diabetes Research (DZD), researchers are currently investigating whether and how intervention programs for lifestyle changes in people with prediabetes can be better adapted to the individual. The aim is to prevent more patients than was previously possible from developing overt diabetes. Throughout Germany, eight universities and research institutes are involved in the research project. The research group from Tübingen University Hospital led by Professor Andreas Fritsche and Professor Norbert Stefan has now published initial results from the “Tübingen Lifestyle Intervention Program (TULIP)”, on which the PLIS study is based. The results indicate that even prior to the lifestyle intervention the chance of success is predictable.

A lifestyle change with increased physical activity and a healthy diet is considered to be the most important measure in the prevention of type 2 diabetes. This is also true for patients who have already developed prediabetes. Experience shows, however, that the success of the lifestyle intervention varies greatly from individual to individual: Some people with prediabetes, who although they successfully change their diet, lose weight and increase their physical activity, still have a high risk for developing overt diabetes later in life.

Together with their colleagues, Professor Norbert Stefan and Professor Andreas Fritsche of Tübingen University Hospital have identified two phenotypes based on data from the “Tübingen Lifestyle Intervention Program (TULIP)” that predict in which patients a lifestyle intervention can induce a sufficiently high reduction of elevated blood glucose levels. Accordingly, what is decisive for the success of the intervention is whether patients have an insulin secretion disturbance and/or a combination of non-alcoholic fatty liver disease accompanied by insulin resistance. “People with these phenotypes achieved almost identical weight loss in comparison to persons who did not have this constellation. However, the probability that they would reach normal blood glucose levels was 4.5 times less,” said Professor Stefan. The normalization of elevated blood glucose levels is considered an important indicator of successful diabetes prevention.

The new findings have two important implications for the prevention of type 2 diabetes and its sequelae. First, the scientists in Tübingen were able to confirm that the phenotypes of type 2 diabetes are very heterogeneous. Based on the study results, meaningful phenotyping seems to be possible in the future. This is a prerequisite that prediabetes patients can receive the best possible targeted preventive measures. Second, individualized prevention approaches are needed. “To achieve this, further studies are required,” said Professor Fritsche. The phenotyping study by the Tübingen research group is now the basis for the design of the PLIS study, which is being carried out nationwide in multiple centers. Its aim is to find out whether a more intensive lifestyle intervention can reduce the risk of diabetes in patients who do not respond to conventional programs.

People interested in participating in this study may obtain more information from the DZD Head Office, Phone: +49 (0)89/3187-2832 or e-mail:

The German Center for Diabetes Research (DZD) is one of six German Centers of Health Research. It brings together experts in the field of diabetes research and combines basic research, epidemiology and clinical applications. By adopting an innovative, integrative approach to research, the DZD aims to make a substantial contribution to the successful, personalized prevention, diagnosis and treatment of diabetes mellitus. The members of the association are the Helmholtz Zentrum München – the German Research Center for Environmental Health, the German Diabetes Center (DDZ) in Düsseldorf, the German Institute of Nutrition (DifE) in Potsdam-Rehbrücke, the Institute of Diabetes Research and Metabolic Diseases (IDM) at the University of Tübingen and the Paul Langerhans Institute at the Carl Gustav Carus University Hospital in Dresden,  associated partners at the universities of Cologne, Heidelberg, Leipzig, Lübeck and Munich, as well as other project partners.

Stefan N, Staiger H, Wagner R, Machann J, Schick F, Häring HU, Fritsche A. A high-risk phenotype associates with reduced improvement in glycaemia during a lifestyle intervention in prediabetes. Diabetologia. 2015 Sep 24. [Epub ahead of print], 10.1007/s00125-015-3760-z