Lifestyle changes for patients with prediabetes: why it doesn’t work for everyone

This study investigated whether response to lifestyle changes can be predicted in prediabetic patients.

Prediabetes is a condition in which blood glucose (sugar) levels are higher than normal but not high enough to be considered type 2 diabetes (T2D). Patients with prediabetes produce insulin but have insulin resistance (reduced ability of insulin to work in the body). Patients with prediabetes have a high risk of developing T2D.

In order to reverse glucose levels to normal, lifestyle intervention is recommended. Lifestyle intervention includes dietary changes and increased exercise. However, some prediabetic patients will still develop T2D even though they have made lifestyle changes. It is thought that these patients may have some characteristics which can predict response. 

This study aimed to identify characteristics which can predict whether patients with prediabetes will respond to lifestyle changes.

This study involved 120 patients with prediabetes. All participants carried out a 9 month lifestyle intervention program. Insulin secretion, insulin sensitivity (ability of insulin to work) and the fat content of the liver were measured at the beginning of the study. These measurements were also recorded at the end of the study. 

55% of participants who carried out the 9 month lifestyle intervention did not have prediabetes reversed. 40% of participants who had a large amount of fat loss did not respond to the lifestyle intervention.

Participants who had low insulin sensitivity and greater non-alcoholic fatty liver disease (NAFLD) had a higher risk of not responding to lifestyle changes. Low-risk patients had greater insulin sensitivity and less NAFLD. The decrease in body fat at the end of the 9 month study was similar between high-risk patients and low-risk patients. Low-risk patients were 4.5 times more likely to have prediabetes reversed.

This study concluded that insulin secretion and insulin sensitivity can be used to identify which prediabetic patients will respond to lifestyle changes.

The sample size was very small. This made it difficult to confirm that the identified characteristics can predict response lifestyle changes.