Remission of Pre-Diabetes is Possible Even Without Weight Loss

For decades, people diagnosed with pre-diabetes — a condition affecting up to one in three adults, depending on age — have been advised by doctors to eat healthily and lose weight to prevent diabetes. However, this approach has not been effective for everyone. Despite unchanged medical recommendations for over 20 years, the global prevalence of diabetes continues to rise. Most individuals with pre-diabetes struggle to meet weight loss goals, leaving them demotivated and still at high risk for diabetes.

Our latest research, published in the scientific journal Nature Medicine, unveils a completely different approach. We found that pre-diabetes can go into remission — with blood sugar returning to normal — even without weight loss. About one in four individuals in lifestyle intervention programs normalize their blood sugar without shedding pounds. Remarkably, this weight-stable remission protects against future diabetes with the same effectiveness as remission achieved through weight loss.

This marks a significant shift in how doctors can treat overweight or obese patients at high risk of diabetes. But how is it possible to lower blood sugar levels without losing weight, or even while gaining weight? The answer lies in how body fat is distributed. Not all body fat behaves the same way.

Visceral fat, located deep in the abdomen around internal organs, acts as a metabolic disruptor. This abdominal fat causes chronic inflammation that interferes with insulin, the hormone responsible for controlling blood sugar levels. When insulin cannot function properly, blood glucose rises.

Conversely, subcutaneous fat — the fat directly under the skin — can be beneficial. This type of adipose tissue produces hormones that help insulin work more effectively. Our study shows that individuals who reverse pre-diabetes without weight loss transfer fat from the abdomen’s interior to beneath the skin, even if their total weight remains the same.

We also uncovered another piece of the puzzle. Natural hormones, mimicked by new weight loss medications like Wegovy and Mounjaro, appear to play a crucial role in this process. These hormones, particularly GLP-1, assist pancreatic beta cells in secreting insulin when blood sugar levels rise.

Individuals who reverse pre-diabetes without losing weight seem to naturally improve this hormonal system while suppressing other hormones that typically raise glucose levels. Targeting fat redistribution
The practical implications are encouraging. Instead of solely focusing on the scale, those with pre-diabetes can aim to reduce body fat through diet and exercise. Research indicates that polyunsaturated fatty acids, abundant in fish oil, olives, and nuts-rich Mediterranean diets, can help reduce belly visceral fat. Similarly, resistance training can decrease abdominal fat, even without overall weight loss.

This does not mean that weight loss should be abandoned as a goal — it remains beneficial for overall health and diabetes prevention. However, our findings suggest that achieving normal blood glucose levels, regardless of weight changes, should become the primary goal in pre-diabetes treatment.

This approach could aid millions of individuals struggling with traditional weight loss programs, yet may still achieve significant health improvements through metabolic changes.

For healthcare professionals, this research hints at the need to broaden treatment approaches beyond weight-focused interventions. Monitoring improvements in blood sugar and promoting fat redistribution through targeted nutrition and exercise can provide alternative paths to diabetes prevention for patients struggling with weight loss.

The implications extend globally, where diabetes is one of the fastest-growing health challenges. By recognizing that pre-diabetes can improve without weight loss, we open new possibilities for preventing a disease affecting hundreds of millions worldwide and rapidly expanding. This research fundamentally reshapes diabetes prevention, suggesting that improvements in metabolic health — not just weight reduction — should be central in clinical practice. For many individuals living with pre-diabetes and feeling disheartened by unsuccessful weight loss attempts, this offers renewed hope and practical alternative strategies to reduce diabetes risk.