Background: Intensive lifestyle intervention (ILI) prevents progression from prediabetes (Predm) to type 2 diabetes (T2D). Here we assessed reversion to normal glucose regulation (NGR) following ILI.

Subjects and Methods: The PROP-ABC (Pathobiology and Reversibility of Prediabetes in a Biracial Cohort) study followed an established cohort of African Americans (AA) and European Americans (EA) with parental T2D for 5 years and initiated ILI in subjects with Predm and those with newly incident Predm. ILI was started after variable intervals from onset of Predm, targeting 10% weight loss through calorie restriction, physical activity, and meal replacements. Serial assessments included anthropometry, fasting plasma glucose (FPG) and lipid levels, OGTT, IVGTT and insulin sensitivity. The primary endpoint was reversion to NGR.

Results: We studied 210 PROP-ABC participants: mean (SD) age 53.3(9.28) y; BMI 30.6(6.70) kg/m2; 70% female, 52.4% AA, 47.6% EA. Predm subjects (N=138) initiated ILI after a latency of 4.08 (2.02) years (range 3 months-8 years), and were stratified into < 3 years (n=32), 3-5 years (n=59) or >5 years (n=47), between onset of Predm and initiation of ILI. Control (N=72) were NGR subjects not receiving ILI. After 5y, FPG (-6.91±1.13 mg/dl vs.1.23 ± 1.43 mg/dl, P=0.0008), 2hPG (-8.23 ±3.27 mg/dl vs.-4.90 ± 8.63 mg/dl, P=0.08) and weight (-2.64 ± 0.85 kg vs. 1.24±1.13 kg, P= 0.04) decreased among ILI participants vs. control. Reversion to NGR occurred in 43.5%, stable Predm in 50%, and T2D in 6.5%. These outcomes did not differ significantly by time to initiation of ILI (chi-square P=0.901). Reversion to NGT occurred within 12 months of ILI and was significantly predicted by BMI, waist size, insulin sensitivity, insulin secretion, and HDL-c (P= 0.04-0.001).

Conclusion: Starting ILI within 3 months to 8 years of occurrence of prediabetes prevented T2D in >90% and restored NGR in ~44% of AA and EA subjects with parental T2D, regardless of time to initiation of ILI.


N.A. Umekwe: None. I. Owei: None. A.A. Brewer: None. L. French: None. D.J. James: None. F. Ariganjoye: None. S. Dagogo-Jack: Board Member; Self; Jana Care Inc. Consultant; Self; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Sanofi-Aventis. Research Support; Self; AstraZeneca, Novo Nordisk Inc. Stock/Shareholder; Self; Dance Biopharm Holdings Inc.


National Institutes of Health (R01DK067269)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at