For people with abnormally high blood sugar levels, losing weight is often proposed as the primary approach to preventing full-blown diabetes from developing.
A new study challenges this approach by evaluating the efficiencies of other methods to bring levels back to safer levels.
The international team of researchers behind the study found that the risk of type 2 diabetes could be cut by as much as 71 percent by following dietary and exercise guidelines, even if participants lost little to no weight.
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While these findings don’t dismiss the importance of losing weight in reducing diabetes risk, they could prompt a rethink on which outcomes to prioritize in strategies to treat prediabetes.
“Restoring a normal fasting blood sugar level is the most important goal in preventing type 2 diabetes and not necessarily the number on the scale,” says diabetologist Andreas Birkenfeld, from the University of Tübingen in Germany.
The study involved 1,105 people with prediabetes, who were advised to follow a 12-month program to improve their diet and exercise routines to lose weight. Of the 234 members who hadn’t lost weight by the end of the year, 51 still met the blood sugar criteria for prediabetes remission.
Follow-up checks on the participants were carried out for up to 10 years. Those in the group of 51 were some 71 percent less likely to have developed type 2 diabetes, compared to the other 183.
The result is similar to the 73-percent-reduction in risk seen in participants who had lost weight and reached prediabetes remission after a year, compared to those who had lost weight but saw no remission.
A further analysis on a subset of the volunteers revealed that the location of fat storage in the body is a significant factor. The group whose blood sugar levels returned to normal without weight loss had a lower percentage of visceral fat (around the organs) compared to those whose blood sugar levels stayed elevated.
This reflects what we know about the relationship between visceral fat and insulin resistance.
“Exercise and a balanced diet have a positive effect on blood sugar levels, regardless of whether weight is reduced,” says Birkenfield. “Losing weight remains helpful, but our data suggests that it is not essential for protection against diabetes.”
The researchers want to see the guidelines for treating prediabetes place less focus on tracking body mass, which risks discouraging those at risk of diabetes who are unsuccessful in losing weight.
“In the future, guidelines for the prevention and treatment of type 2 diabetes should not only take weight into account, but above all blood glucose control and fat distribution patterns,” says Reiner Jumpertz-von Schwartzenberg, from the University of Tübingen.
The research has been published in Nature Medicine.
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