Weight-loss programmes reduce blood sugar levels in adults with prediabetes — Study

Structured weight-loss programmes may help adults with prediabetes improve their blood sugar levels, with digital support and intensive counselling showing promising results, a systematic review has found.

The review examined six studies conducted in the United States, the United Kingdom, the Netherlands and New Zealand and published between 2011 and 2022. All six reported reductions in glycated haemoglobin (HbA1c), a measure of average blood sugar levels over approximately two to three months.

The researchers, including Ayokunle Osonuga and Nicholas Aderinto, said the findings highlight the potential role of structured lifestyle interventions in primary care, although the extent of improvement varied across programmes. The study was published in Primary Care Diabetes.

One of the most notable findings came from Alive-PD, an automated digital programme designed to help participants adopt healthier lifestyle habits. After six months, participants using the programme recorded an average HbA1c reduction of 0.26 percentage points, compared with 0.18 percentage points among those in the control group.

A separate US study found that more intensive behavioural counselling was associated with greater reductions in HbA1c. Participants who received 24 counselling sessions over six months recorded a reduction of 0.11 percentage points, compared with 0.08 points among those who received 16 sessions and 0.03 points among those who received eight sessions. The nutrition-education control group recorded a reduction of 0.02 points.

These findings suggest that sustained support may offer greater benefits than less intensive interventions, although differences in study design make direct comparisons difficult.

A UK pilot study involving 27 adults assessed a low-carbohydrate diet app for people with prediabetes. Among those who completed the programme, average weight loss was 4.08kg at 12 months, while mean HbA1c fell from 45.56 to 43.21 mmol/mol.

Another UK service evaluation involving 1,207 patients found that brief primary-care consultations lasting between 15 and 30 minutes were followed by a reduction in average HbA1c from 43.85 to 41.63 mmol/mol over 12 months.

The findings suggest that routine healthcare appointments could provide opportunities to encourage healthier eating, weight management and other positive lifestyle changes. However, the evaluation does not establish that the consultations alone caused the improvement.

Beyond blood sugar control, several studies reported reductions in body weight or body mass index. Some also recorded favourable changes in cholesterol levels, blood pressure and physical activity.

The review also highlighted the importance of participation and adherence, as the benefits of lifestyle programmes may depend on whether participants sustain the recommended changes. However, adherence was not consistently reported across the studies.

The researchers noted that differences in programme design, participant characteristics and outcome measurements, alongside generally short follow-up periods of six to 12 months, limit the conclusions that can be drawn.

They called for larger studies with longer follow-up to establish which interventions deliver lasting benefits and how they can be implemented across different healthcare systems. All six studies were conducted in high-income countries, leaving their effectiveness in lower- and middle-income settings uncertain.

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Prediabetes occurs when blood sugar levels are higher than normal but remain below the threshold for a diagnosis of type 2 diabetes. Lifestyle changes, including healthier eating, increased physical activity and weight management, are commonly recommended to help reduce the risk of developing the condition.

The researchers concluded that structured weight-loss programmes delivered through primary care could form part of efforts to prevent type 2 diabetes.

“Digital tools and sustained counselling appear promising, but further evidence is needed to determine which approaches work best and for whom,” they said.