13.
3 How to reverse prediabetes &
type 2 diabetes
How to reverse prediabetes & type 2 diabetes
By Bonnie Liebman, MS
Updated: November 16, 2022.
Fifteen percent of U.S. adults have diabetes. Another 38 percent have prediabetes (and 8 out of
10 of them don’t know it). Together, that comes to 1 in 2 adults with harmful blood sugar levels.
The good news: Many cases can be prevented and, in some people, even reversed. Here's what to
know.
1. Got prediabetes? You can prevent type 2 diabetes.
The news hit in 2002. That’s when researchers at 27 sites nationwide reported the results from
the Diabetes Prevention Program. For nearly three years, the DPP had randomly assigned 3,234
people with prediabetes to an “intensive lifestyle intervention,” a diabetes drug called metformin,
or a placebo.
“The lifestyle intervention reduced the risk of type 2 diabetes by 58 percent, and metformin
reduced the risk by 31 percent compared to those who got a placebo,” says Dana Dabelea,
professor of epidemiology and pediatrics at the University of Colorado.
The lifestyle intervention had two parts. “It focused on reducing dietary fat intake and promoting
at least 150 minutes of physical activity per week, with a goal of meeting a weight-loss target of
about 7 percent,” says Dabelea.
Why eat less fat? It helped people cut calories.
“It was really about weight loss,” explains Dabelea. “A later analysis estimated that a weight loss
of 5 kilograms—11 pounds—accounted for about a 60 percent reduction in the risk of diabetes.”
(The average participant started the trial at roughly 200 pounds.)
“And people who had more than the average 7 percent weight loss and met their physical activity
goals—they reducedLinks to an external site. their diabetes risk by 90 percent.”
“This was one of the first papers to suggest that type 2 diabetes can be not just delayed but
prevented.”
Exercise plus weight loss can help prevent type 2 diabetes
Exercise helped, even if participants didn’t hit their weight-loss target.
“Those who met the goal of at least 150 minutes of physical activity a week reduced their risk of
diabetes by 44 percent, even if they didn’t lose 7 percent of their initial weight,” notes Dabelea.
“So physical activity might help prevent diabetes above and beyond weight loss, although weight
loss is the most important component.”
“The message of the DPP is that if you lose weight, you’re going to substantially reduce your
risk of diabetes.”
What does it take to put type 2 diabetes in remission?
Greater weight loss can drive type 2 diabetes into remission in some people.
In 2019, the DiRECT trial reported that among people who were randomly assigned to lose about
30 pounds with a very-low-calorie liquid formula diet, 46 percent no longer had blood sugar
levels in the diabetes range after a year. (Some of the study’s authors had ties to the companies
that sold the formula.)
But the weight often comes back. That’s why physicians are excited about new drugs like
Mounjaro (tirzepatide) and Ozempic (semaglutide), which may cut blood sugar not only by
keeping weight off but by boosting insulin secretion and sensitivity. (Those drug studies were
industry funded.)
“This new class of drugs is very promising for reverting to normal blood sugar and treating
obesity,” says Dabelea. “It’s early, but the drugs offer new hope for people with type 2 diabetes.”
2. Even prediabetes isn't harmless.
“Without weight loss and moderate physical activity, 15–30% of people with prediabetes will
develop type 2 diabetes within 5 years,” says the Centers for Disease Control and Prevention.
But the goal isn’t just to keep people from crossing the line into diabetes, say researchers. It’s to
reverse prediabetes—that is, to return blood sugar levels to normal.
Why? Excess blood sugar can harm the tiniest blood vessels in the eyes, kidneys, nerves, heart,
and elsewhere in the body.
“Diabetes remains a leading cause of blindness, kidney failure, and amputations,” notes Dabelea.
And the damage can start early.
“The DPP and many other studies have shown that the risk of retinopathy, nephropathy,
neuropathy, and cardiovascular disease increases when blood sugar is in the prediabetes range,”
explains Dabelea.
The good news: A third of the DPP participants got their blood sugar down to normal during the
three-year trial.
“They had a 50 percent lower risk of diabetes 10 years down the road,” says Dabelea. “And they
had a lower incidenceLinks to an external site. of microvascular and cardio-
vascular complications.”
Her takeaway: “Prediabetes is not benign.”
Dennis Cox/stock.adobe.com.
3. What's the best diet for prediabetes or type 2
diabetes?
What’s the best diet for people with prediabetes or type 2 diabetes?
“Everyone agrees that we should all cut back on added sugar and refined grain and eat lots of
non-starchy vegetables,” says Christopher Gardner, professor of medicine at the Stanford
University School of Medicine.
That’s the most recent advice from the American Diabetes Association, which Gardner co-
authored.
The ADA also recommended “whole foods over highly processed foods” and, for those with
diabetes, reducing carbs to keep a lid on blood sugar.
But cutting back on refined grains and added sugar isn’t exactly a piece of cake.
If you look at what Americans eat, animal protein, plant protein, saturated fat, monounsaturated
fat, polyunsaturated fat, and high-quality carbs (whole grains, beans, whole fruits, and non-
starchy vegetables) each supplies roughly 10 percent of our calories, notes Gardner.
“What’s the elephant in the room?” he asks. “It’s the low-quality carbs.”
That’s refined grains, added sugar, fruit juice, potatoes, and other starchy vegetables, which
supply nearly 40 percent of our calories.
What the "Keto-Med" trial tested
“Some studies have tested a low-carbohydrate keto diet versus a crappy low-fat diet that’s high
in white flour and added sugar,” Gardner points out.
But that stacks the deck against low-fat.
So his “Keto-Med” trialLinks to an external site. had 33 people with prediabetes or type 2
diabetes eat either a “Well-Formulated Ketogenic Diet” or a “Mediterranean-Plus” diet for 12
weeks and then switch to the other diet for 12 weeks, followed by 12 more weeks of eating
whatever they wanted.
“Both diets had no added sugar or refined grain and lots of nonstarchy vegetables, and both were
lower-carb, but the keto diet was extremely low,” explains Gardner.
What’s more, the keto diet replaced most of the carbs with fat, not protein.
“Some people think, ‘A keto diet is great—I can eat all the meat I want,’” says Gardner. “But if
you eat too much protein, you’ll throw yourself out of ketosis.” (That’s when your body burns
ketones instead of carbs for energy.)
Why? “Once you’ve met your protein needs, the body has no place to store the excess, so the
protein gets converted to carbs,” explains Gardner.
“And protein triggers the release of insulin when you’re trying to keep your insulin down.”
The Mediterranean diet supplied plenty of healthy fats. “It had olive oil, avocado, nuts, and
seeds,” says Gardner.
“But it was high in three things you can’t eat in keto: beans, fruits, and whole, intact grains.
That’s the central question we were trying to answer: Do you need to avoid those foods?”
The ketogenic diet
Gardner’s “well-formulated ketogenic diet” had more than 3 servings of non-starchy vegetables
and only 20 to 50 grams of carbs a day.
phoka/stock.adobe.com.
The Mediterranean diet
Gardner’s Mediterranean diet was rich in plants—vegetables, fruits, beans, nuts, seeds, olive oil,
intact whole grains—plus fish.
marilyn barbone/stock.adobe.com.
The impact of a Keto vs. Med diet on blood sugar, cholesterol, and more
The key result: Hemoglobin A1c—a long-term measure of blood sugar—didn’t differ between
the two diets.
But that’s not the whole story.
“Hemoglobin A1c and weight dropped on both diets,” notes Gardner. The differences:
Triglycerides dropped more on keto. “That doesn’t surprise me because you’re getting rid of so
many carbs,” says Gardner. “And keto was worse for LDL—or ‘bad’—cholesterol.”
That’s not trivial, given that cardiovascular disease is the No. 1 killer of people with diabetes.
The keto diet had other downsides. “In the last 12 weeks, most people weren’t following the
diets—especially the keto—anymore,” notes Gardner.
And when people did follow the keto diet, “they had lower intakes of folate, vitamin C,
magnesium, and especially fiber,” he adds. “They weren’t deficient after 12 weeks, but that
might have an impact long term.”
Gardner’s bottom line: “I don’t think it’s a wash. I don’t think there’s any reason to get rid of
legumes, grains, and fruits when so many recommendations from the American Heart
Association, World Health Organization, and others promote them. The evidence in favor of a
keto diet just doesn’t overturn that advice, even for people with diabetes.”
10 tips to dodge type 2 diabetes
1. Are you at risk for type 2 diabetes? Take the American Diabetes Association's 60-
second quiz.
2. The best way to dodge prediabetes or diabetes is to lose (or not gain) extra pounds.
3. No diet leads to weight loss unless it helps you cut calories.
4. Many "keto" ice creams, breads, waffles, cookies, candies, and cereals have no fewer
calories than their regular versions.
5. Cutting carbs—especially white flour, potatoes, juice, and sugary drinks—may help
lower blood sugar even if you don’t lose weight.
6. Replace unhealthy carbs with unsaturated fats like olive or canola oil, nuts, avocado,
and fatty fish.
7. Fill half your plate with non-starchy vegetables.
8. If you have type 2 diabetes, don’t try a very-low-calorie or a low-carb diet without a
doctor’s help. They may cause dangerously low blood sugar, and your doctor may
need to adjust your medications.
9. If you have prediabetes, find a CDC-recognized in-person or online Diabetes
Prevention Program.
10. Aim for at least 30 minutes of brisk walking or other aerobic exercise daily
