Researchers created a new prediction tool to help people with prediabetes understand their personal risk of developing type 2 diabetes and find the best prevention strategy for them individually. Using health data from nearly 2,800 Americans, they tested three approaches: following standard healthy lifestyle advice, taking the medication metformin, or doing an intensive lifestyle program with major diet and exercise changes. The results show that intensive lifestyle changes work best for most people, reducing diabetes risk from 18% down to just 8%. This personalized approach could help doctors and patients make smarter decisions about preventing diabetes before it develops.

The Quick Take

  • What they studied: Can we predict who will get diabetes and figure out which prevention method works best for each person individually?
  • Who participated: Nearly 2,800 American adults who had prediabetes (higher-than-normal blood sugar but not yet diabetes) from national health surveys between 2015 and 2020
  • Key finding: Intensive lifestyle changes reduced the 3-year diabetes risk from 18% down to 8%, while medication (metformin) reduced it to 14%. For 91% of people studied, intensive lifestyle was the best option for preventing diabetes.
  • What it means for you: If you have prediabetes, this suggests that making serious changes to diet and exercise may be more effective than medication alone for preventing diabetes. However, the best approach depends on your individual situation, and you should discuss options with your doctor.

The Research Details

Researchers used health information collected from a large, representative group of Americans through national health surveys. They took this real-world data and plugged it into a special computer model that predicts diabetes risk. This model was already tested and proven to be accurate in previous studies. The researchers then used the model to test what would happen if people followed three different prevention strategies: doing nothing special (just standard healthy living advice), taking metformin pills, or doing an intensive lifestyle program with major changes to eating and exercise habits.

For each person in the study, the model calculated what their diabetes risk would be under each of these three scenarios. This allowed the researchers to see which approach would work best for each individual person, rather than recommending the same thing to everyone. They looked at the results across the entire group to see which prevention method was best for most people.

This research matters because it shows how doctors can use personalized medicine—tailoring treatment to each person’s unique situation—for diabetes prevention. Instead of giving everyone the same advice, this tool helps identify which prevention strategy will work best for each individual based on their specific health characteristics. This could make prevention programs more effective and help people avoid developing diabetes.

The study used a validated prediction model, meaning it was already tested and shown to work accurately in other research. The researchers used data from a nationally representative sample, which means the results likely apply to Americans across the country, not just one specific group. The study analyzed a large number of people (2,778), which makes the findings more reliable. However, this was a prediction study using a computer model rather than actually following people over time to see who actually developed diabetes, so real-world results may differ slightly.

What the Results Show

The study found that without any special prevention efforts, people with prediabetes had an 18% chance of developing diabetes within 3 years. When researchers looked at what would happen if people took metformin (a common diabetes medication), the risk dropped to 14%—a meaningful improvement but not dramatic.

However, when the model calculated what would happen with intensive lifestyle changes (significant improvements in diet and exercise), the risk dropped much more dramatically to just 8%. This means intensive lifestyle changes cut the diabetes risk roughly in half compared to doing nothing special.

When the researchers looked at which prevention method was best for each individual person based on their unique health profile, the results were striking: for 91% of the people studied (about 9 out of 10), the intensive lifestyle approach was predicted to work better than medication. Only a small percentage of people had medication as their optimal choice.

The study also showed that the combination of intensive lifestyle plus medication didn’t provide much additional benefit beyond intensive lifestyle alone. This suggests that for most people, focusing energy on major lifestyle changes is more important than adding medication. The research demonstrates that a personalized approach—using a prediction tool to identify the best strategy for each person—could help prevent many cases of diabetes in the general population.

This research builds on previous studies that showed intensive lifestyle programs can prevent diabetes. The major advance here is the personalized approach—rather than recommending the same thing to everyone, this tool helps identify the best strategy for each individual. Previous research has shown that both metformin and lifestyle changes work, but this is one of the first studies to systematically compare them and show that lifestyle changes are superior for most people.

This study used a computer prediction model rather than actually following people over time to see who developed diabetes, so the real-world results might be somewhat different. The study included data from 2015-2020, so it may not reflect changes in the population since then. The model was based on U.S. data, so results may not apply to other countries. Additionally, the study didn’t account for how difficult it might be for people to actually stick with intensive lifestyle changes in real life—the model assumes people can and will follow through with whatever approach is recommended.

The Bottom Line

If you have prediabetes, this research suggests that intensive lifestyle changes (major improvements in diet and exercise) are likely to be more effective than medication alone for preventing diabetes. The evidence for this is strong (based on previous research and this new analysis). However, the best approach for you personally depends on your individual health situation, preferences, and ability to make lifestyle changes. Talk with your doctor about which approach makes the most sense for you. Some people may benefit from combining lifestyle changes with medication, especially if lifestyle changes alone seem too difficult.

This research is most relevant for people with prediabetes who are trying to decide how to prevent diabetes. It’s also important for doctors and healthcare providers who counsel patients about diabetes prevention. People with normal blood sugar levels don’t need to worry about this research. People who already have type 2 diabetes should follow their doctor’s treatment plan rather than using this prevention information.

The predictions in this study are for a 3-year timeframe. If you start intensive lifestyle changes, you might see improvements in blood sugar levels within weeks to months, but the full benefit for preventing diabetes develops over months to years. Most people should expect to see meaningful results within 6-12 months of consistent effort.

Want to Apply This Research?

  • Track weekly minutes of moderate exercise (aim for 150+ minutes per week) and log daily food intake focusing on whole grains, vegetables, and lean proteins while reducing sugary drinks and processed foods. Monitor fasting blood sugar levels monthly if available.
  • Set a specific, measurable goal like ‘walk 30 minutes, 5 days per week’ and ‘replace one sugary drink daily with water.’ Use the app to log workouts and meals, set reminders for exercise, and track progress toward these concrete targets.
  • Check in weekly on exercise and nutrition goals. Have blood sugar tested every 3 months through your doctor to see if your lifestyle changes are working. Use the app to review monthly trends in activity and diet to identify patterns and adjust strategies as needed.

This research provides general information about diabetes prevention strategies and should not replace professional medical advice. If you have prediabetes or concerns about your diabetes risk, consult with your healthcare provider before starting any new diet, exercise program, or medication. Individual results vary based on genetics, health conditions, and ability to maintain lifestyle changes. This study used a prediction model rather than following real people over time, so actual outcomes may differ. Always work with your doctor to develop a personalized prevention plan appropriate for your specific health situation.