An international research team led by University Hospital Tübingen and the DZD published an article in Nature Medicine calling for a fundamental shift in how we prevent type 2 diabetes.
The core argument:
Type 2 diabetes develops over decades, but prevention usually starts only when blood sugar is already high. The team argues prevention needs to start much earlier and continue across the entire life course.
They identify 6 critical windows:
- Before pregnancy – both parents’ metabolic health matters
- Pregnancy
- Early childhood
- Adolescence
- Young adulthood
- Midlife to older adulthood
The release notes pregnancy and breastfeeding are key opportunities to shape health for both generations.
A new central goal: remission, not just slowing disease
Instead of just trying to slow progression, the authors say the goal should be to restore metabolic health and keep it.
This is especially important for prediabetes — when blood sugar is elevated but not yet at diabetes levels. The panel stresses prediabetes is not irreversible, and that lifestyle interventions can return glucose to normal. People who achieve this “prediabetes remission” have a substantially lower long-term risk.
“Prediabetes remission—meaning a return to normal blood glucose levels—should therefore become a central goal of prevention,” says senior author Prof. Andreas L. Birkenfeld.
The ten-point framework
The paper presents the first international expert consensus with ten priorities for the future of prevention, including:
- Life-course risk assessment that accounts for biological, social, and behavioral factors
- Personalized prevention strategies instead of one-size-fits-all
- Making prediabetes remission a central prevention target
- Using digital and AI-supported tools
- Reducing health inequities
- Focusing research, prevention, and healthcare on maintaining metabolic health long-term
Led by Prof. Birkenfeld and first author Yiying Wang from Tübingen, the framework was developed with leading experts in basic research, clinical medicine, and diabetes prevention.