A new study from the German Center for Diabetes Research (DZD), University Hospital Tübingen, and Helmholtz Munich found that long-term weight loss and lifestyle changes don’t prevent type 2 diabetes for all high-risk groups.
Key findings:
The study background
- Researchers previously identified 6 distinct risk clusters for type 2 diabetes. Clusters 3 and 5 have especially high diabetes risk.
- This study looked at whether lifestyle interventions work equally well across those clusters. It used data from the Tübingen Lifestyle Intervention Program (TULIP), where high-risk participants did a 2-year lifestyle program and were tracked for ∼9 years total.
What happened to Cluster 5
- Participants in risk cluster 5 achieved substantial, sustained weight loss of 8% over 9 years.
- Despite this, they still showed:
- Rising blood glucose levels
- Declining insulin secretion
- Persistently high diabetes risk
- This surprised researchers, since weight loss + diet + exercise usually prevent type 2 diabetes effectively.
Why Cluster 5 is different
- The likely cause: pronounced fatty liver disease and insulin resistance
- These factors appear to impair insulin secretion from pancreatic beta cells, driving blood glucose up even when weight stays down.
- Cluster 5 has previously been linked to higher susceptibility to both type 2 diabetes and cardiovascular disease.
What this means
- Standard lifestyle interventions may not be enough for people in risk cluster 5.
- If confirmed in future studies, precision prevention strategies will be needed. High-risk groups like cluster 5 may require more intensive or targeted interventions beyond typical diet and exercise programs.
The research was published in the journal Diabetes and led by Professor Norbert Stefan.