2002NEJM
Diabetes Prevention Program
3,234 adults with prediabetes
Losing 7% of body weight and doing 150 minutes of activity a week cut new diabetes by 58%; the drug metformin cut it by 31%.
Find on PubMed ↗Research library · Food & life
Blood sugar: keeping the spikes in check
Years of high blood sugar damage blood vessels, nerves, eyes and kidneys. More than 1 in 3 adults in the US has prediabetes and most don't know it. The good news: daily habits beat medicine at stopping it from becoming diabetes.
Strong evidenceUpdated Oct 2026 · 4 new studies−58%new diabetes in people with prediabetes who lost 7% of their weight and walked 150 min a weekDPP 2002, NEJM, 3,234 people
−26%deaths over 30 years after a 6-year lifestyle programmeDa Qing study, Gong 2019, Lancet Diabetes Endocrinol
2–5 minof light walking after a meal is enough to blunt the sugar spikeBuffey 2022, Sports Med, meta-analysis
01
The basics
How your body handles sugar
When you eat carbohydrates, they're broken down into glucose (sugar) that enters your blood. Your pancreas releases insulin, a hormone that works like a key, opening cells in your muscles, liver and fat so glucose can move in and be used or stored.
With too little activity, too much belly fat and poor sleep, cells start to ignore insulin. This is insulin resistance. The pancreas pumps out more and more insulin to compensate, often for 10 years or more, before blood sugar finally rises. First comes prediabetes, then type 2 diabetes.
Muscle is the biggest place glucose goes after a meal, and working muscles can take up glucose even without insulin. That's why walking after meals and strength training are so effective.
A walk after eating flattens the spike
Illustration of blood sugar after the same meal. Light walking soon after eating helps muscles pull sugar out of the blood.
02
How it works
From meal to muscle
1
Meal
Carbohydrates are digested into glucose, which enters your blood.
2
Insulin released
The pancreas sends insulin to unlock cells.
3
Muscles take it in
Most glucose is stored in muscle; moving muscles pull in even more.
4
Liver & fat store the rest
Excess is stored in the liver or turned into fat.
03
Measure it
Which tests to ask for
- HbA1c: shows your average blood sugar over the past 2–3 months. No fasting needed.
- Fasting glucose: after 8+ hours without food. 70–99 mg/dL (under 5.6 mmol/L) is normal; 100–125 (5.6–6.9) is prediabetes.
- Fasting insulin: not routine, but a high value can reveal insulin resistance years before sugar rises.
- Continuous glucose monitors (CGMs): a sensor on your arm shows how your blood sugar responds to meals in real time. Useful for learning, not needed by everyone.
Try your number
NormalPrediabetesDiabetes range
4.58
American Diabetes Association cut-offs. Diagnosis needs a doctor and usually two tests.
04
What the research says
The key studies
2015Lancet Diabetes Endocrinol
DPP Outcomes Study
Most of the original DPP group, 15 years
Fifteen years on, the lifestyle group still had 27% less diabetes.
Find on PubMed ↗2019Lancet Diabetes Endocrinol
Gong et al. (Da Qing)
577 adults in China, 30 years
Six years of diet and exercise delayed diabetes by about 4 years and cut heart events and deaths by about a quarter over 30 years.
Find on PubMed ↗2022Sports Medicine
Buffey et al.
7 studies
Even 2–5 minutes of light walking after eating lowered blood sugar compared with sitting. Standing helped a little.
Find on PubMed ↗2015Diabetes Care
Shukla et al.
11 adults with type 2 diabetes
Eating vegetables and protein before carbohydrates cut the blood sugar rise after a meal by about a third.
Find on PubMed ↗2018Lancet
Lean et al. (DiRECT)
306 people with type 2 diabetes
Nearly half went into remission after a structured weight-loss programme, showing type 2 diabetes can often be reversed.
Find on PubMed ↗05
New in 2025–26
What the newest research adds
New long-term data show that getting blood sugar back to normal in prediabetes roughly halves later heart risk, so remission is worth aiming for. At the same time, experts warn that glucose monitors have not been shown to help people without diabetes, and sugary drinks look far worse than sugar eaten in food.
The new studies, in order
Every study added to this page since January 2025. Green rings are the strongest evidence: large trials or meta-analyses.
Getting back to normal blood sugar protects the heart
Vazquez Arreola et al., 2025. Heart deaths or heart failure admissions per 1,000 people per year, 20 to 30 years after prediabetes, in two long-running trials.
NewDec 2025Lancet Diabetes Endocrinol
Vazquez Arreola et al. (DPPOS and DaQingDPOS)
2,942 adults with prediabetes, 20 to 30 years
People whose blood sugar returned to normal had about a 58% lower risk of dying from heart disease or being admitted with heart failure, and 42% fewer heart attacks and strokes. Results were similar in the US and China.
Good evidenceRead the source ↗
NewMay 2025Adv Nutr
Della Corte et al.
over 800,000 adults, 29 cohort studies
Each daily can of sugary drink was linked to about 25% higher risk of type 2 diabetes, and each daily glass of fruit juice to about 5% higher. Sugar eaten in whole foods was not linked to higher risk.
Good evidenceRead the source ↗
NewAug 2026JAMA Intern Med
Dower et al.
evidence review
The authors found no evidence that continuous glucose monitors improve health or prevent disease in people without diabetes. They warn that normal glucose ups and downs can be over-read, leading to needless food rules and worry.
Good evidenceRead the source ↗
NewApr 2026J Endocrinol Invest
Galindo et al. (SURMOUNT-5)
425 adults with obesity and prediabetes, 72 weeks
In this follow-up analysis of a drug trial, 90% of people on tirzepatide and 76% on semaglutide had normal blood sugar again by 72 weeks. Weight fell by about 21.5% and 14.5%.
Good evidenceRead the source ↗
What this changes for you
If a test says you have prediabetes, aim to get back to normal, not just to stop it getting worse; the heart payoff is large. Swap sugary drinks and juice for water, tea or coffee. A glucose monitor is optional if you don't have diabetes.
06
Take action
How to keep blood sugar steady
Small habits around meals make a surprisingly big difference.
- 1
Walk after meals
10 minutes after your biggest meals; even 2–5 minutes helps.
- 2
Eat in the right order
Vegetables and protein first, starchy foods last.
- 3
Choose slow carbs
Whole grains, beans and lentils over white bread, rice and sugary cereal.
- 4
Drop sugary drinks
Soft drinks and juices are the fastest way to spike blood sugar.
- 5
Lift weights
More muscle means more space to store glucose.
- 6
Sleep and lose a little
Losing 5–7% of body weight and sleeping 7+ hours both improve insulin sensitivity.
07
Myth or fact
Common myths, checked
✕ MythEating sugar directly causes diabetes.
✓ FactType 2 diabetes is driven mainly by excess body fat, inactivity, genes and age. Sugary drinks raise risk through weight gain and liver fat.
✕ MythPeople with diabetes can't eat fruit.
✓ FactWhole fruit has fibre and is linked to lower diabetes risk. Juice is the problem.
✕ MythEveryone needs a glucose monitor.
✓ FactThey're helpful for learning but not needed for most healthy people.
✕ MythPrediabetes isn't serious.
✓ FactIt raises heart risk already, and up to 70% of people with it eventually develop diabetes without changes.
08
Questions
Frequently asked
How often should I get tested?
Every 3 years from age 35 (earlier if overweight or with family history). Yearly if you have prediabetes.
Is a sugar spike after a meal bad?
Some rise is normal. Big, frequent spikes and slow returns to baseline are what matter.
Does artificial sweetener help?
Swapping sugary drinks for diet ones helps short term. Water, tea and coffee are better long-term habits.
09
Test yourself
True, partly true or myth?
Read each claim and pick an answer: the card flips to show the verdict and why. Not sure? Use “Just reveal”.
Card № 01True or myth?
A walk of 10–15 minutes after a meal lowers the blood sugar spike.
True
A walk of 10–15 minutes after a meal lowers the blood sugar spike.
Studies show light walking after eating blunts the rise, because working muscles pull glucose out of the blood.
Card № 02True or myth?
Only people with diabetes need to care about blood sugar.
Myth
Only people with diabetes need to care about blood sugar.
Prediabetes is very common and usually silent. Insulin resistance builds for years before a diagnosis.
Card № 03True or myth?
Eating vegetables and protein before carbs can lower the glucose spike from a meal.
True
Eating vegetables and protein before carbs can lower the glucose spike from a meal.
Small trials show food order reduces the peak, especially in people with type 2 diabetes.
Card № 04True or myth?
Fruit is bad because it contains sugar.
Partly true
Fruit is bad because it contains sugar.
Whole fruit comes with fibre and is linked to lower diabetes risk. Fruit juice is a different story.
Card № 05True or myth?
HbA1c shows your average blood sugar over about three months.
True
HbA1c shows your average blood sugar over about three months.
It measures how much sugar has stuck to red blood cells, which live around 120 days.
Card № 06True or myth?
A single glucose spike on a monitor means a food is unhealthy for you.
Myth
A single glucose spike on a monitor means a food is unhealthy for you.
Spikes after meals are normal. What matters most is your overall average and how quickly levels come back down.
Card № 07True or myth?
Type 2 diabetes can go into remission with large weight loss.
True
Type 2 diabetes can go into remission with large weight loss.
In the DiRECT trial, almost half of people who followed a diet programme were in remission after one year.
Card № 08True or myth?
Artificial sweeteners help with blood sugar.
Partly true
Artificial sweeteners help with blood sugar.
They don't raise glucose directly, but long-term benefits are unclear and the WHO advises against relying on them for weight control.
Card № 09True or myth?
Poor sleep makes blood sugar control worse the next day.
True
Poor sleep makes blood sugar control worse the next day.
Even one night of short sleep reduces insulin sensitivity in healthy adults.
Card № 10True or myth?
Brown sugar and honey are much healthier than white sugar.
Myth
Brown sugar and honey are much healthier than white sugar.
They're almost the same to your body: mostly glucose and fructose, with tiny amounts of minerals.
Nothing here yet. Try another filter.
10
Sources
References and related topics
- Diabetes Prevention Program (2002). NEJM. 3,234 adults with prediabetes. PubMed ↗
- DPP Outcomes Study (2015). Lancet Diabetes Endocrinol. Most of the original DPP group, 15 years. PubMed ↗
- Gong et al. (Da Qing) (2019). Lancet Diabetes Endocrinol. 577 adults in China, 30 years. PubMed ↗
- Buffey et al. (2022). Sports Medicine. 7 studies. PubMed ↗
- Shukla et al. (2015). Diabetes Care. 11 adults with type 2 diabetes. PubMed ↗
- Lean et al. (DiRECT) (2018). Lancet. 306 people with type 2 diabetes. PubMed ↗
- Vazquez Arreola et al. (DPPOS and DaQingDPOS) (2025). Lancet Diabetes Endocrinol. 2,942 adults with prediabetes, 20 to 30 years. Source ↗
- Della Corte et al. (2025). Adv Nutr. over 800,000 adults, 29 cohort studies. Source ↗
- Dower et al. (2026). JAMA Intern Med. evidence review. Source ↗
- Galindo et al. (SURMOUNT-5) (2026). J Endocrinol Invest. 425 adults with obesity and prediabetes, 72 weeks. Source ↗