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Jump to Key Points Type 2 diabetes (T2D) typically develops over many years, yet preventive efforts often do not begin until blood glucose levels are already elevated. Now, an international panel of experts led by the University Hospital of Tübingen in Tübingen, Germany, and the German Center for Diabetes Research in Neuherberg, Germany, is urging a fundamental shift in approach: Diabetes prevention should be viewed across the entire life course.
This so-called life-course approach views diabetes prevention not as a single measure in adulthood but as an ongoing task spanning the entire lifespan. Six life stages are crucial in this context:
- from the period before pregnancy
- through pregnancy,
- early childhood,
- adolescence, and
- young adulthood
- to middle age
In Nature Medicine, lead author Yiying Wang, a doctoral candidate in medicine at the University Hospital of Tübingen, and her colleagues have formulated, for the first time, a joint 10-point catalog for the prevention of T2D.
Even Parental Metabolism May Play a Role
“Many people think of diabetes prevention primarily in terms of diet and exercise in adulthood,” said Wang in a press release from the University Hospital of Tübingen. She emphasized that the risk of developing the disease later in life is shaped much earlier: Even the metabolic health of the mother and father before pregnancy can influence their child’s future metabolic health. Pregnancy and breastfeeding offer further important opportunities to positively shape the health of both generations.
- T2D prevention should span life course: preconception → middle age.
- Parental metabolic health before pregnancy may shape offspring risk.
- Screening should move beyond age/BMI; include weight trends, GDM, family hx, biomarkers.
- Dysglycemia is heterogeneous; IFG and IGT may need different prevention strategies.
- Prevention endpoints should include CVD, CKD, mortality, life expectancy; equity essential.
That is why, according to Andreas L. Birkenfeld, MD, director of the Department of Diabetology, Endocrinology, and Nephrology at the University Hospital of Tübingen and a member of the Executive Board of the German Center for Diabetes Research, preventive measures must begin much earlier and take individual risks into account throughout the entire lifespan.
Rethinking Diabetes Prevention — the 10-Point Catalog
- Moving away from threshold values toward a biologically grounded classification: “Prediabetes” is a misleading term for a continuous and biologically heterogeneous process of metabolic decline. Early-stage T2D should be defined based on pathophysiologic risk and disease progression, not solely on glucose levels.
- Redesigning screening protocols across the entire lifespan: Waiting until hyperglycemia develops in middle age is no longer sufficient. Screening protocols should incorporate weight trends, gestational dysglycemia, family history, and newly identified biomarkers — rather than relying primarily on age- and BMI-based criteria.
- Recognize heterogeneity within dysglycemia: Dysglycemia is not a uniform metabolic state. Impaired fasting glucose and impaired glucose tolerance are clinical manifestations of a broader biological heterogeneity and should not automatically trigger identical prevention strategies.
- Ensuring lasting remission: Remission must reflect a biological modification of the disease and not merely a temporary normalization of blood glucose levels. Predictive markers are needed to determine who can achieve remission, who cannot, and who is at risk for relapse.
- Prevention must not wait for abnormal glucose levels: Maintaining metabolic resilience. Preserved insulin sensitivity, beta-cell adaptability, weight stability, and metabolic flexibility, should become a primary prevention goal.
- Intervene when the body is most adaptable: Critical windows of opportunity for prevention range from the period before conception through pregnancy to childhood and adolescence. Context-specific strategies should reflect the life-course risk profile.
- Develop dynamic precision tools for prevention: AI and multimodal data integration can support adaptive risk models that incorporate genetics, omics, life events, and environmental influences. The goal is to identify modifiable turning points.
- Define the role of pharmacotherapy in prevention: Effective incretin-based therapies and other novel therapies could play a role in selected high-risk groups. Prevention must avoid both therapeutic inertia and indiscriminate medicalization.
- Call for evidence on specific clinical endpoints: Prevention studies must go beyond glycemic endpoints and assess cardiovascular events, kidney disease, other diabetes-related conditions, premature mortality, and healthy life expectancy.
- Prioritize equity: Diabetes prevention must not become a matter of privilege. Scalable, affordable, and culturally appropriate strategies are essential, and individuals and communities at an increased risk should be involved in shaping prevention efforts.
This story was translated from Medscape’s German edition.
