New Research Questions Whether Weight Loss Alone Can Prevent Type 2 Diabetes - Video

Losing weight and maintaining a healthy lifestyle are well-established ways to lower the risk of type 2 diabetes. However, a new study published in Diabetes suggests that these measures may not provide the same level of protection for everyone, particularly those with a specific high-risk metabolic profile.

Researchers from the German Center for Diabetes Research (DZD), University Hospital Tübingen, and Helmholtz Munich found that people belonging to Tübingen's type 2 diabetes risk cluster 5 continued to experience worsening blood sugar control despite achieving significant long-term weight loss.

The study followed participants enrolled in the Tübingen Lifestyle Intervention Program (TULIP), a two-year lifestyle program involving healthy eating, weight loss, and increased physical activity. Participants were then monitored for approximately nine years.

The analysis focused on individuals who successfully lost around 8% of their body weight and maintained that weight loss over the long term.

Despite these sustained improvements, people in risk cluster 5 showed rising blood sugar levels, declining insulin production, and a persistently high likelihood of developing type 2 diabetes. In contrast, participants in other risk groups generally experienced greater metabolic benefits from lifestyle changes.

The researchers believe the reduced response may be driven by severe insulin resistance associated with fatty liver disease. Excess fat stored in the liver may impair the pancreas' ability to produce sufficient insulin, causing blood sugar levels to continue rising even after weight loss.

Previous research has already shown that cluster 5 is characterized by marked fatty liver and insulin resistance, placing individuals at particularly high risk of both type 2 diabetes and cardiovascular disease.

The findings suggest that a "one-size-fits-all" approach to diabetes prevention may not be effective. Instead, people with high-risk metabolic profiles may require personalized prevention strategies, including treatments that specifically target insulin resistance and fatty liver disease alongside lifestyle modification.

REFERENCE: Caroline Z. Meier, Robert Wagner, et al.; Different Metabolic Responses to Long-term Weight Loss After Lifestyle Intervention Among Type 2 Diabetes Risk Clusters: Results From the TULIP Study. Diabetes, 2026; 75 (6): 965 DOI: 10.2337/db25-0757