Greater weight loss and supervised exercise reduce diabetes risk in adults with prediabetes

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Worldviews on evidence-based nursing Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Rong Jincheng, Ho Mandy, Zhou Disheng, Chau Pui Hing PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider weight loss goals and supervised exercise for prediabetes prevention.

This meta-analysis evaluated the effectiveness of lifestyle interventions involving diet and physical activity for adults with prediabetes. The primary focus was on the incidence of type 2 diabetes, with secondary assessments of normoglycemia and various metabolic markers. The study pooled data from a large number of participants to determine the relationship between intervention characteristics and clinical outcomes.

The results indicated that greater weight loss was associated with larger reductions in diabetes incidence. Achieving a weight loss of five percent or more was linked to higher rates of reversion to normoglycemia compared to smaller weight loss. Furthermore, interventions that included supervised exercise training demonstrated more effective reductions in diabetes risk than those without such supervision.

Additional findings showed that younger participants generally experienced greater improvements in metabolic parameters. Higher baseline hemoglobin A1c levels were associated with greater reductions in this marker but smaller improvements in fasting insulin. The authors note that weight loss remains a critical determinant for diabetes prevention.

Based on these observations, the authors recommend that clinicians set weight loss goals and monitor progress in their patients. Adding supervised exercise sessions can enhance the overall effectiveness of the prevention program. Early interventions targeting younger individuals with lower baseline hemoglobin A1c levels may prevent diabetes more effectively.

Study Details

Study typeMeta analysis

Sample sizen = 22,629

EvidenceLevel 1

PublishedJun 2026

PMID42163067

View Original Abstract ↓

BACKGROUND: Despite the evidence for the efficacy of lifestyle interventions for type 2 diabetes prevention, there remains a gap in translating this evidence-based practice into real-world settings. AIMS: To summarize current evidence regarding the relationship between participant characteristics, intervention components, and the effect of lifestyle interventions for individuals with prediabetes. METHODS: The initial search of PubMed, Embase, the Cochrane Library, and Web of Science was performed on 6th December 2023 and was subsequently updated on 5th October 2025. Randomized controlled trials on lifestyle interventions (diet and/or physical activity), compared to usual care, no intervention, or wait-list control, in adults with prediabetes were eligible. Outcomes included the incidence of type 2 diabetes and normoglycemia, fasting plasma glucose (FPG), 2-h plasma glucose, hemoglobin A1c (HbA1c), fasting insulin (FI), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Random-effects meta-analyses were performed to estimate relative risks (RRs) and mean differences. Subgroup analyses and meta-regressions were conducted by participant characteristics and intervention components. RESULTS: Seventy-seven studies (n = 22,629 participants) were included. Greater weight loss (%) was associated with larger reductions in diabetes incidence (β = 0.07 [0.02, 0.12], p = 0.010). Achieving ≥ 5% (vs. < 5%) weight loss was associated with higher reversion rates to normoglycemia (RR = 1.80 [1.55; 2.08] vs. 1.32 [1.03; 1.70]; p = 0.036). Interventions with supervised exercise training more effectively reduced diabetes incidence than those without this component (RR = 0.40 [0.24; 0.65] vs. 0.69 [0.63; 0.76]; p = 0.031). Younger participants showed greater improvements in FPG, HbA1c, FI, and HOMA-IR. Higher baseline HbA1c levels were associated with a greater reduction in HbA1c but a smaller FI improvement. LINKING EVIDENCE TO ACTION: This meta-analysis provides valuable insights into the implementation of diabetes prevention programs. Weight loss is a critical determinant for diabetes prevention, and weight loss goal setting and progress monitoring are recommended. Adding supervised exercise sessions can enhance the program's effectiveness. Early interventions for younger individuals with lower HbA1c levels may prevent diabetes more effectively. TRIAL REGISTRATION: PROSPERO (CRD42024486361).