A recent study suggests that the current one-size-fits-all approach to preventing type 2 diabetes in prediabetes patients may be missing opportunities to implement preventative strategies for those at highest risk.
This finding is particularly relevant given the increasing diagnosis of prediabetes and type 2 diabetes in adults under 40. Type 2 diabetes can lead to long-term health burdens, including heart disease, kidney disease, stroke, and nerve damage in the brain, eyes, and feet.
Dr. Mary Rooney, who led the research at the Johns Hopkins Bloomberg School of Public Health, explained that even as individuals with prediabetes generally have a higher risk of progressing to type 2 diabetes, there are significant differences in individual risk levels.
5-Year Diabetes Progression Risk: Over 3x Difference
Researchers tracked 662 adults aged 18-40 diagnosed with prediabetes for an average of seven years, analyzing their risk of developing type 2 diabetes within five years. The results showed substantial variation in risk levels among individuals.
The average risk of progressing to type 2 diabetes within five years for all participants was 7.5%. The group meeting the criteria for GLP-1 receptor agonist (GLP-1 RA) treatment had a higher risk of 10.9%. Those with fasting blood glucose levels between 110-125mg/dL faced a risk of 15.1%, and the risk climbed to 24.8% for those with high fasting blood glucose and meeting the criteria for GLP-1 RA treatment. So some individuals with prediabetes could be in a high-risk group where one in four will develop diabetes within five years.
Rooney stated, “Currently, type 2 diabetes prevention strategies are essentially applied in the same way to all patients.” She added, “These results display that a more actively personalized approach is needed for some high-risk groups.”
GLP-1 Medications: Could They Help with Prevention?
GLP-1 receptor agonists (GLP-1 RA) are currently approved for the treatment of type 2 diabetes and obesity, and are used in conjunction with lifestyle modifications like diet and exercise for weight loss. Prescription criteria include a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher with at least one weight-related comorbidity, such as hypertension or hyperlipidemia.
Researchers suggest that GLP-1 RA medications may help prevent the progression to type 2 diabetes in overweight or obese prediabetes patients with other related conditions. However, they clearly stated that “the cost-effectiveness in these high-risk groups has not yet been sufficiently verified.”
The American Heart Association (AHA) emphasizes that weight loss, a balanced diet, and regular physical activity are crucial for reducing the risk of diabetes progression. These lifestyle changes also reduce the risk of hypertension, myocardial infarction, and stroke.
This research was presented as preliminary data at the 2026 American Heart Association Scientific Sessions (EPI|Lifestyle Scientific Sessions) in Boston from March 17-20.
[Frequently Asked Questions]
Q1. Does everyone with prediabetes progress to diabetes?
No. The average progression risk in this study was about 7.5%, but individual risk varied up to 24.8%. Some are in a high-risk group, but not everyone will develop diabetes.
Q2. Who is at higher risk of progressing to diabetes?
Those with higher fasting blood glucose levels (110-125mg/dL), or who have obesity or metabolic diseases like hypertension and hyperlipidemia are at higher risk. The risk significantly increases when these conditions are present together.
Q3. Can GLP-1 diet drugs prevent diabetes?
Currently, GLP-1 medications are approved only for diabetes treatment or weight loss. They are not approved for diabetes prevention. While a potential benefit is suggested in some high-risk groups, the cost-effectiveness and preventative effects have not been fully proven.
