Health
You can still cut your diabetes risk, even if your weight won’t budge
Prediabetes often arrives quietly, but your ability to reverse it is stronger than you think. Researchers have found that improving blood sugar control – even with no weight loss – can slash the risk of developing type 2 diabetes
By Carolyn Tate
If you've got prediabetes, or you’re in a high-risk category, chances are your doctor has told you to lose weight. And there’s nothing wrong with that – but what if the scales aren't budging despite your best efforts?
Well, it turns out weight loss might not be the golden ticket we thought it was. New research shows that normalising your blood sugar levels matters more than the number on the scales when it comes to preventing type 2 diabetes. Better yet, you can create some daily habits and start seeing results well before you lose a single kilo.
A new study from Germany's University of Tübingen tracked over 1100 people with prediabetes and found that those who brought their blood sugar back to normal range – even without losing weight and in some cases while gaining weight – slashed their risk of developing type 2 diabetes by 71%. That's practically the same result as people who did lose weight (who saw a 73% risk reduction).
What this actually means for you
About one in 10 adults has prediabetes, but the real number is probably much higher because it usually develops silently with no symptoms. It happens when your blood sugar levels creep above normal but aren't yet high enough to be classified as diabetes. Left unchecked, it can progress to type 2 diabetes, which affects over 460 million people worldwide, and increases your risk of heart disease and certain cancers.
"Restoring a normal fasting blood sugar level is the most important goal in preventing type 2 diabetes, and not necessarily the number on the scale," says Professor Andreas Birkenfeld, who led the study. "Exercise and a balanced diet have a positive effect on blood sugar levels, regardless of whether weight is reduced."
Read this too: Wake up, Australia - we have a blood sugar problem
The researchers also discovered something interesting about fat distribution. People who normalised their blood sugar without losing weight still showed a reduction in visceral fat – that's the dangerous fat stored deep in your abdomen around your organs, not the subcutaneous fat just under your skin (more on this here). Visceral fat produces inflammatory chemicals that disrupt your hormones and increase insulin resistance, so where your fat sits matters as much as how much you have.
Nutritionist Edwina Ekins from Nutrition 4 Performance explains what this means in practical terms. "This research highlights that managing blood sugar levels is another potential lever in preventing type 2 diabetes," she says.
"I need to be clear that excess weight, especially visceral fat around the waist area, is still considered a major risk factor. However, focusing on blood sugar control is another mechanism to improve your metabolic health and is complementary to any weight loss strategy. That's a big shift in thinking – and good news for people who are trying to reduce their risk."
The really encouraging part in all this is that your day-to-day food choices have a powerful effect on blood glucose levels and energy, even before the scales move.
Why meal timing matters
Something many of us get wrong is that when you eat can be just as important as what you eat.
Ekins recommends eating three balanced meals spaced 3–5 hours apart – basically a regular breakfast, lunch and dinner routine. "Skipping meals can cause blood glucose to drop, leading to irritability (those 'hangry' episodes) and overeating at the next meal, followed by a large spike in blood sugar," she explains.
And despite what intermittent fasting advocates might tell you, Ekins suggests a protein-rich breakfast – aim for 20 grams of protein – before 9:30am. "This early dose of protein has been shown to support better blood glucose control throughout the day."
Another clever strategy is to time your carbohydrate intake around exercise. "If you're going for a 60-plus minute walk or workout, have a slice of grainy toast with peanut butter beforehand to fuel your training,” says Ekins. “Then, eat your main meal afterwards, when your body is primed to use glucose to replenish energy stores."
It's not just what you eat, it's how you combine it
Blood sugar rises when we eat carbohydrates, but not all carbs are created equal – and what you eat with them also makes a massive difference.
"Combine carbs with protein, healthy fats and fibre to slow digestion and prevent glucose spikes," Ekins says. "Don't eat pasta or bread on their own. Add fish, chicken or tofu for protein and a couple of cups of vegetables for fibre to the plate."
The glycaemic index (GI) matters too. Low-GI carbs break down more slowly and prevent glucose spikes. Think grainy sourdough instead of white bread, or basmati or brown rice instead of jasmine rice.
"People are often surprised to learn that refined carbohydrates like white bread, white rice and low-fibre breakfast cereals can raise blood sugar as much, or more, than table sugar," Ekins says.
Even healthy carbs like brown rice or pasta can spike your blood sugar if the portion is too large or you eat them without protein, fat or fibre. As a guide, a serve of rice is just ¼ cup cooked, and pasta is ½ cup cooked – smaller than most of us think.
The Mediterranean-style diet ticks all the boxes for blood sugar control. It emphasises vegetables, legumes, whole grains, olive oil and fish, and it's backed by strong evidence for metabolic health and heart disease prevention.
More on this: Mediterranean diet 101: healthy eating for healthy ageing
The simple exercise trick that works
Exercise improves how your body uses glucose, helping lower blood sugar both immediately and over time. But timing matters here too.
"Even a 10 to 20-minute walk after meals, especially lunch or dinner, can reduce the post-meal glucose spike," Ekins says. "It doesn't need to be strenuous – a relaxed stroll is enough to activate glucose uptake into muscles."
Morning exercise is still beneficial, but that post-meal activity gives an added benefit for blood sugar control. Think of it as a walk that keeps on giving.
Should you invest in a glucose monitor?
Continuous glucose monitors (CGMs) are available over the counter in Australian pharmacies, and they’re having a bit of a moment on social media as a health monitor for all – not just diabetics. They last two weeks and provide detailed feedback on how different meals and activities affect your glucose levels.
"For most people, diet and lifestyle changes are enough," Ekins says. "However, using a CGM for a short period can be a useful tool if you want to understand how specific foods affect your body, or if you're motivated by seeing your own data in real time."
It's important to know that all foods containing carbohydrates will raise blood sugar – that's normal. But CGMs help you identify what causes large spikes or crashes. Responses are also highly individual: a bowl of pasta might spike your glucose but have little effect on your partner's.
"A CGM isn't essential for prevention, but it can be a useful self-awareness tool,” says Ekins. “Ideally interpreted with guidance from a qualified health professional."
The hidden factors affecting your blood sugar
Two major factors that often get overlooked when it comes to blood sugar are sleep and stress.
Poor sleep, even for just a few nights, increases insulin resistance. Chronic stress raises cortisol levels, which in turn increases blood sugar. "Managing stress with movement, mindfulness, breathing exercises or even just social connection can have measurable effects on blood glucose control," Ekins says.
Meal timing plays a role here too. Avoid skipping meals, avoid eating late at night and stick to a consistent routine with regular meals, adequate sleep, and a stable bedtime. "Supporting your body's natural rhythms helps maintain blood sugar balance over the long term," Ekins adds.
The takeaway
Professor Birkenfeld and his team are calling for updated guidelines. "In future, guidelines for the prevention and treatment of type 2 diabetes should not only take weight into account, but above all blood glucose control and fat distribution patterns," says Professor Reiner Jumpertz-von Schwartzenberg, who co-authored the study.
But for those of us trying to stay healthy, the key message is simple: you have more control than you think. Blood sugar management isn't just about willpower or watching the scales – it's about smart meal timing, balanced plates, regular movement (especially after meals), decent sleep and managing stress. Start with one or two changes that feel doable and build from there. Your body should respond, even if the scales take a little bit longer to get the message.
The information on this page is general information and should not be used to diagnose or treat a health problem or disease. Do not use the information found on this page as a substitute for professional health care advice. Any information you find on this page or on external sites which are linked to on this page should be verified with your professional health care provider.
Feature image: iStock/Morsa Images
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