Targeted Treatment for Prediabetes May Prevent Type 2 Diabetes, Study Suggests

A one-size-fits-all approach to prediabetes treatment may miss opportunities for early, intensive and tailored prevention, particularly for those at highest risk of developing Type 2 diabetes, according to preliminary research presented at the American Heart Association’s EPI|Lifestyle Scientific Sessions 2026.¹ The conference, held in Boston from March 17-20, 2026, features the latest research on epidemiology, prevention, lifestyle, and cardiometabolic health.

Rising Rates of Prediabetes and Type 2 Diabetes

Diagnosis of Type 2 diabetes and prediabetes is increasing among adults aged 40 and younger.¹ Complications of Type 2 diabetes include heart disease, kidney disease, stroke, and nerve damage affecting the brain, eyes, and feet.¹

GLP-1 Receptor Agonists and Risk Stratification

Individuals with prediabetes are at a higher risk of progressing to Type 2 diabetes and its associated complications.¹ Recently, the U.S. Food and Drug Administration (FDA) has approved weight-loss medications, known as GLP-1 Receptor Agonists (GLP-1RA), for select patients meeting specific criteria.¹ Researchers utilized these criteria to estimate the risk of developing Type 2 diabetes in young adults with prediabetes.

Currently, some GLP-1 RA medications are FDA-approved for treating Type 2 diabetes, even as others are approved to aid weight loss when diet and exercise are insufficient.¹ Eligibility for GLP-1 RA medications for weight loss typically includes a body mass index (BMI) of 30 kg/m² or higher, or a BMI of 27 kg/m² or higher plus a related condition like high blood pressure or high cholesterol.¹ However, GLP-1 RA medications are not currently FDA-approved for preventing Type 2 diabetes in individuals with prediabetes.

Study Findings on Progression Risk

The analysis estimated the 5-year risk of progression from prediabetes to Type 2 diabetes in 662 young adults.¹ Participants were followed for an average of seven years through three U.S.-based studies focused on young adult health and heart disease risk.¹

The analysis revealed:

• The overall 5-year risk of progressing from prediabetes to Type 2 diabetes was 7.5%.¹
• The risk increased to 10.9% for individuals who met the criteria for treatment with a GLP-1RA medication for weight loss.¹
• The 5-year risk grew to 15.1% for those with higher fasting glucose levels (110-125 mg/dL).¹
• The risk reached 24.8% for those with higher fasting glucose levels and who met the criteria for treatment with a GLP-1 RA medication.¹

Implications for Prevention Strategies

“Current approaches to Type 2 diabetes prevention are ‘one-size-fits-all.’ Our results signal that some people with prediabetes have a higher risk of progressing to Type 2 diabetes. These are the patients who may benefit from more targeted, intensive treatment than others,” said Mary Rooney, Ph.D., M.P.H., lead author of the study and assistant research professor, department of epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore.¹

The American Heart Association recommends lifestyle changes – including weight loss, a healthy diet, and regular physical activity – to reduce the progression of prediabetes to Type 2 diabetes and manage existing Type 2 diabetes, as well as mitigate other risk factors like high blood pressure, heart attacks, and stroke.¹

The study also suggests that GLP-1 RA medications may be beneficial in preventing progression to Type 2 diabetes in people with prediabetes who meet BMI criteria for overweight or obesity and have other weight-related health conditions.¹

“However, the cost-effectiveness of GLP-1 RA medications for Type 2 diabetes prevention, particularly in subgroups with the highest risk for Type 2 diabetes, is not yet known,” said Rooney.¹

Expert Commentary

“Different groups of people with Type 2 diabetes may need different prevention strategies based on their level of risk,” said Joshua J. Joseph, M.D., M.P.H., FAHA, ASCI, an American Heart Association volunteer expert and chair of the Lifestyle Diabetes Committee for the Association’s Council on Lifestyle and Cardiometabolic Health. “A next step would be to study a larger and more diverse group of people so we can better understand how factors like where someone lives, such as a rural or urban setting, their background and their community influence risk. These findings support the idea of acting early, before Type 2 diabetes and related heart or kidney conditions become more serious, using healthy lifestyle changes and, when needed, medications to lower risk, consistent with the cardiovascular-kidney-metabolic syndrome framework, which prioritizes early intervention.”¹ Joseph is an associate professor of internal medicine and the endowed professor for research in internal medicine at The Ohio State University Wexner Medical Center in Columbus, Ohio.¹

Study Details

The study included 662 young adults from three U.S. Studies: the Hispanic Community Health Study/Study of Latinos, the Coronary Artery Risk Development in Young Adults study, and the Framingham Heart Study Third Generation.¹ Participants were aged 18-40 (mean age of 32 years) and had prediabetes.¹ The participant group was 33% women, 47% self-identified as Hispanic/Latino, 45% as non-Hispanic White, and 7% as non-Hispanic Black.¹ Health information, including fasting glucose levels, weight, BMI, lipid levels, and blood pressure, was collected between 1985 and 2011, before the first FDA approval of GLP-1 RA medications for weight loss.¹

The study’s findings are limited because hemoglobin A1c blood tests, which measure blood sugar levels over the past 2-3 months, were not available.¹ Only fasting glucose tests were included in the analysis.¹

¹EPI|Lifestyle Scientific Sessions 2026 – Professional Heart Daily