From the Guidelines
To help with weight loss in prediabetes, refer adults to an intensive lifestyle behavior change program consistent with the Diabetes Prevention Program (DPP) to achieve and maintain 7% loss of initial body weight, and increase moderate-intensity physical activity to at least 150 min/week. This approach is based on the most recent and highest quality study, which emphasizes the importance of lifestyle changes in preventing type 2 diabetes and associated comorbidities 1.
Key Components of Weight Loss in Prediabetes
- A variety of eating patterns can be considered to prevent diabetes in individuals with prediabetes, including a reduced-calorie diet emphasizing vegetables, lean proteins, whole grains, and healthy fats while limiting processed foods, sugary beverages, and refined carbohydrates 1
- Increase moderate-intensity physical activity to at least 150 min/week, combining cardio and strength training
- Behavioral strategies such as regular meal timing, portion control, adequate sleep (7-9 hours), stress management, and tracking food intake are also important
Medications and Other Interventions
- Metformin can help with insulin sensitivity and modest weight loss, but its use should be considered on a case-by-case basis 1
- GLP-1 receptor agonists like semaglutide (Wegovy, Ozempic) or tirzepatide (Mounjaro) are effective for significant weight loss but may require insurance approval
- Certified technology-assisted diabetes prevention programs may be effective in preventing type 2 diabetes and should be considered based on patient preference 1
Importance of Lifestyle Changes
- Even modest weight loss delays progression from pre-DM to T2DM, with each additional kilogram loss associated with 43% lower odds of T2DM 1
- Lifestyle intervention in IGT significantly reduces the development of T2DM, with a reduction in vascular complications
- Maintenance of weight loss for 5 years is recommended, with a goal of achieving and maintaining 7% loss of initial body weight 1
From the Research
Options for Weight Loss in Prediabetes
There are several options available to help with weight loss in individuals with prediabetes, including:
- Lifestyle modifications, such as diet and exercise, which are considered first-line treatments 2, 3, 4
- Pharmacologic interventions, such as metformin, which has been shown to decrease the risk of diabetes among individuals with prediabetes 2, 3, 4
- Therapeutic agents, such as GLP-1 receptor agonists (e.g. liraglutide) and SGLT2 inhibitors, which have been shown to be effective for weight loss in individuals with type 2 diabetes and may also be beneficial for those with prediabetes 4, 5
- Bariatric surgery, which is another efficacious means of preventing type 2 diabetes in patients with prediabetes and obesity 2
Dietary Interventions
Dietary interventions can be an effective way to achieve weight loss in individuals with prediabetes. Some studies have investigated the use of:
- Low-fat diets 6
- Personalized diets using machine-learning algorithms to predict glycemic response to meals 6
- Calorie restriction and increased physical activity 3, 4
Medications
Several medications have been shown to be effective in preventing type 2 diabetes in individuals with prediabetes, including:
- Metformin, which has been shown to decrease the risk of diabetes by 3.2 cases per 100 person-years during 3 years 3
- GLP-1 receptor agonists, such as liraglutide, which has been shown to result in weight loss over 56 weeks in overweight and obese participants with type 2 diabetes 5
- Alpha-glucosidase inhibitors (e.g. Acarbose), inhibitors of pancreatic lipase (e.g. Orlistat), PPAR-gamma agonists (e.g. Rosiglitazone, Pioglitazone), and meglitinides (e.g. Nateglinide) 2