Prediabetes Remission Reduces the Risk of Type 2 Diabetes
A growing number of people have elevated blood sugar values, which is known as prediabetes, a precursor to type 2 diabetes. In a review article, DZD researchers from the Institute for Diabetes Research and Metabolic Diseases (IDM) of Helmholtz Munich at the Eberhard Karl University of Tübingen and the Department of Internal Medicine IV at the University of Tübingen explain what prediabetes is, how many people are affected by it worldwide, and how type 2 diabetes can be prevented. In addition to weight reduction, prediabetes remission to normalized blood sugar values is particularly decisive.
One in 10 adults worldwide lives with prediabetes, while the figure is as high as one in five in Germany. Prediabetes is diagnosed when there is no manifest type 2 diabetes yet, but the fasting blood sugar is already elevated and glucose regulation is impaired. Not only does this increase the risk of type 2 diabetes, but the elevated blood sugar values can in the long term also lead to serious complications, including those affecting the cardiovascular system, liver, and kidneys. Studies show that even in prediabetes, different subtypes exist with varying risks of complications.
Early Prevention of Type 2 Diabetes
“In light of the fact that a prediabetes diagnosis already indicates the presence of significant pathophysiological alterations, such as insulin resistance and/or beta-cell dysfunction, it is crucial to reverse these changes as early as possible to safeguard beta-cell function early and sustainably and to reduce the sequelae of long-standing insulin resistance,” says first author Leontine Sandforth, doctor, clinician scientist fellow of the German Research Foundation (DFG) at the Department of Internal Medicine IV at the University of Tübingen, and DZD researcher.
Normalizing Blood Sugar Values Reduces the Risk of Type 2 Diabetes
But how can this be achieved? To prevent the development of type 2 diabetes as well as damage to blood vessels and organs, lifestyle changes, such as a healthy diet and more exercise, are usually used to combat prediabetes. Recent studies show that, in addition to weight loss, the normalization of blood sugar values (prediabetes remission) particularly reduces the risk of type 2 diabetes. Future studies will demonstrate whether prediabetes remission can also protect against incident diabetes-related comorbidities, such as cardiovascular and/or chronic kidney disease.
Prediabetes Remission and Weight Loss
“To lower the risk of serious complications and type 2 diabetes, targeted prediabetes remission together with guideline-based weight loss should be the primary therapeutic objective in future,” stresses Prof. Andreas Birkenfeld, medical director of the Department of Internal Medicine IV at the University of Tübingen and DZD board member. In future, this could help to prevent type 2 diabetes, improve quality of life for affected individuals, and reduce the global burden of disease.
Important Points from the Review Article
- Prediabetes remission to normal glucose regulation, in addition to standard weight loss, lowers type 2 diabetes risk more than standard weight loss alone.
- Prediabetes remission to normal glucose regulation should be considered in guidelines and recommendations for the delay and prevention of type 2 diabetes.
- Future studies will demonstrate whether prediabetes remission can also protect against incident diabetes-related comorbidities, such as cardiovascular and/or chronic kidney disease.
Original publication:
Leontine Sandforth, Stephanie Kullmann, Arvid Sandforth, Andreas Fritsche, Reiner Jumpertz-von Schwartzenberg, Norbert Stefan, Andreas L. Birkenfeld: Prediabetes remission to reduce the global burden of type 2 diabetes, Trends in Endocrinology & Metabolism, 2025, ISSN 1043-2760, doi.org/10.1016/j.tem.2025.01.004.
Founded in 1805, Tübingen University Hospital is one of the leading centers of German university medicine. As one of the 33 university hospitals in Germany, it contributes to the successful combination of high-performance medicine, research and teaching. Well over 400,000 inpatients and outpatients from all over the world benefit annually from this combination of science and practice. The clinics, institutes and centers unite all specialists under one roof. The experts work together across disciplines and offer each patient the best possible treatment based on the latest research findings. Tübingen University Hospital conducts research for better diagnoses, therapies and healing chances; many new treatment methods are clinically tested and applied here. In addition to diabetology, neuroscience, oncology, immunology, infection research and vascular medicine are research priorities in Tübingen. The Department of Diabetology /Endocrinology has been the center of interdisciplinary research over the past 25 years, especially with the participation of surgery, radiology and laboratory medicine. This important discovery of the prediabetes subtypes was only possible due to the interdisciplinary collaboration between the hospital’s various departments. Tübingen University Hospital is a reliable partner in four of the six German Centers for Health Research initiated by the German Federal Government. www.medizin.uni-tuebingen.de
Helmholtz Munich is a leading biomedical research center. Its mission is to develop breakthrough solutions for better health in a rapidly changing world. Interdisciplinary research teams focus on environmentally triggered diseases, especially the therapy and prevention of diabetes, obesity, allergies and chronic lung diseases. With the power of artificial intelligence and bioengineering, the researchers accelerate the translation to patients. Helmholtz Munich has more than 2,500 employees and is headquartered in Munich/Neuherberg. It is a member of the Helmholtz Association, with more than 43,000 employees and 18 research centers the largest scientific organization in Germany. More about Helmholtz Munich (Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt GmbH): www.helmholtz-munich.de/en
The German Center for Diabetes Research (DZD) is a national association that brings together experts in the field of diabetes research and combines basic research, translational research, epidemiology and clinical applications. The aim is to develop novel strategies for personalized prevention and treatment of diabetes. Members are Helmholtz Munich – German Research Center for Environmental Health, the German Diabetes Center in Düsseldorf, the German Institute of Human Nutrition in Potsdam-Rehbrücke, the Paul Langerhans Institute Dresden of Helmholtz Munich at the University Medical Center Carl Gustav Carus of the TU Dresden and the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the Eberhard-Karls-University of Tuebingen together with associated partners at the Universities in Heidelberg, Cologne, Leipzig, Lübeck and Munich. www.dzd-ev.de/en
