Type 2 Diabetes Prevention Across the Life Course

Type 2 diabetes (T2D) prevention efforts have largely focused on intervening when dysglycemia is already established. However, this approach may not be the most effective way to prevent the disease. Instead, researchers propose that T2D prevention be reframed around prediabetes remission, with preservation and restoration of normoglycemia as the optimal clinical goal. The transition from normoglycemia through increasing dysglycemia to T2D is progressive and cumulatively shaped by biological, behavioral, and environmental exposures across the life course. Prediabetes (intermediate hyperglycemia) remission is an achievable, pragmatic, and measurable prevention target. By understanding the life-course risk architecture for T2D, researchers can identify critical windows of amplified metabolic vulnerability and potential restoration of normoglycemia. This framework can inform precision prevention strategies that target mechanistic heterogeneity, with aligned interventions that remain scalable, affordable, and adaptable across socioeconomic settings. The proposed framework identifies ten priorities in T2D prevention, moving beyond traditional approaches toward context-specific, actionable interventions capable of altering the natural history of disease early in the life course and restoring metabolic health. Research-use only laboratory peptides may be used to support the development of these interventions, but it is essential to note that the use of these peptides for clinical purposes requires careful evaluation and regulatory approval.