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Type 2 diabetes prevention across the life course
Yiying Wang1,2,3, Jennifer L Sargent4,5, Chantal Mathieu6
1Department of Internal Medicine IV-Diabetology, Endocrinology, Nephrology, University Hospital Tübingen, University of Tübingen, Tübingen, Germany.
Nature Medicine
|August 10, 2026
Summary
Reframing type 2 diabetes (T2D) prevention around prediabetes remission offers a pragmatic goal. Focusing on restoring normoglycemia early in life, using a life-course approach, can alter disease progression.
Area of Science:
- Metabolic health and disease prevention
- Public health and epidemiology
Background:
- Current type 2 diabetes (T2D) prevention strategies often begin after dysglycemia is established.
- The progression from normoglycemia to T2D is influenced by cumulative life-course exposures.
- Prediabetes represents an intermediate stage with potential for intervention.
Purpose of the Study:
- To reframe T2D prevention by prioritizing prediabetes remission and restoration of normoglycemia.
- To introduce a life-course risk architecture for T2D, integrating various determinants.
- To identify critical windows for metabolic vulnerability and intervention.
Main Methods:
- Development of a life-course risk architecture for T2D.
- Integration of developmental, transitional, and contextual determinants of metabolic health.
- Identification of critical periods for metabolic vulnerability and normoglycemia restoration.
Main Results:
- Prediabetes remission is proposed as an achievable and measurable prevention target.
- A framework is presented that integrates life-course determinants of T2D risk.
- Ten priorities for T2D prevention are identified, emphasizing precision and context-specific interventions.
Conclusions:
- Shifting focus to prediabetes remission and normoglycemia restoration is crucial for effective T2D prevention.
- A life-course perspective and precision medicine approach are essential for altering the natural history of T2D.
- Scalable, affordable, and adaptable interventions targeting mechanistic heterogeneity can restore metabolic health early in life.