You can significantly reduce your risk of type 2 diabetes by eating a nutritious diet, losing weight, and becoming more physically active. However, lifestyle changes do not seem to provide the same level of protection for everyone.
The researchers report that people assigned to Tübingen’s type 2 diabetes risk cluster 5 continued to experience elevated blood sugar levels, a sharp decline in insulin production, and a consistently increased risk of developing diabetes. These unfavorable changes occurred even among people who lost a lot of weight and maintained that loss for years.
The findings are from scientists at the German Diabetes Research Center (DZD), University Hospital Tübingen and Helmholtz Hospital München. The results were published in a scientific journal diabetes.
Six different type 2 diabetes risk groups
Several years ago, DZD researchers classified people at risk for type 2 diabetes into six well-defined clusters. These groups differ greatly in how often diabetes develops and how diabetes-related complications develop.
Clusters 3 and 5 were identified as particularly likely to develop type 2 diabetes. In the latest analysis, researchers examined whether long-term weight loss and lifestyle-based diabetes prevention had different outcomes across these risk groups.
Cluster 5 remains vulnerable despite weight loss
Researchers analyzed information from the Tübingen Lifestyle Intervention Program (TULIP). Those at high risk for type 2 diabetes participated in a two-year lifestyle program and were then monitored for approximately nine years.
The analysis focused on participants who were able to achieve significant weight loss and maintain it over time.
“We were particularly interested in whether people in risk clusters 3 and 5 differ from those in other clusters when it comes to improving blood sugar levels and preventing type 2 diabetes,” explains Professor Norbert Stephan, lead author of the study. “We were very surprised to find that despite a significant and sustained weight loss of 8%, and after a very long follow-up period of nine years, people in risk cluster 5 continued to have elevated blood sugar levels, reduced insulin secretion, and a higher risk of type 2 diabetes.”
Fatty liver and insulin resistance may increase risk
The researchers also investigated why lifestyle interventions appeared to offer less protection for people in cluster 5. Their analysis focused on biological mechanisms that may explain the poor metabolic health of this group.
This result suggests that insulin resistance plays a major role. This resistance is most likely associated with severe fatty liver disease. Fat accumulation in the liver also impairs the ability of the beta cells in the pancreas to release insulin, which may be responsible for elevated blood sugar levels in cluster 5 people.
This finding supports previous evidence showing that fatty liver disease and insulin resistance are the main disease processes affecting people in Tübingen’s type 2 diabetes risk cluster 5. These characteristics may make them particularly vulnerable to both type 2 diabetes and cardiovascular disease.
Individualized diabetes prevention may be required
This result indicates that people in cluster 5 may not derive metabolic benefits from lifestyle interventions compared to people in other risk groups. This was true even when researchers achieved significant and sustained weight loss, especially when they looked at blood sugar regulation.
If future prospective studies confirm the results, diabetes prevention may need to be more individualized. People with high-risk biological profiles, such as cluster 5, may require more intensive treatment or treatments to address specific metabolic issues.
