Last updated July 14, 2026
Key finding
Cluster 5 participants had a larger increase of adjusted fasting glycemia compared with cluster group 1,2,4,6 and cluster 3.
This study examined the long-term effects of the Tübingen Lifestyle Intervention Program on glycemia and insulin secretion in individuals at high risk for type 2 diabetes, revealing significant increases in fasting plasma glucose and 2-hour plasma glucose levels among certain participants.
Quick read
The essential study design details in one scan.
EvidenceScore™
Moderate
Study type
RCTs
Follow-up
Extended (5–20+ y)
Risk of bias
Some Concerns
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Plain-language summary
A plain-language read of the study’s main message and where it applies.
Study focus
This study examined the long-term effects of the Tübingen Lifestyle Intervention Program on glycemia and insulin secretion in individuals at high risk for type 2 diabetes, revealing significant increases in fasting plasma glucose and 2-hour plasma glucose levels among certain participants.
Understanding the long-term effects of lifestyle interventions like TULIP is crucial for developing effective strategies to prevent type 2 diabetes. The findings suggest that while lifestyle changes are important, they may not be sufficient for all individuals at high risk, particularly those who show significant increases in glycemia and decreased insulin secretion. This highlights the need for tailored interventions and monitoring to better address the needs of at-risk populations.
The study design was non-randomized, which may introduce bias. The sample size for cluster 5 may limit the generalizability of findings. Long-term follow-up data may be incomplete for some participants.
Published in
Publication details and source links for this paper.
Caroline ZM, Robert W, Marlene G, et al. Long-term effects of a lifestyle intervention on glycemia and insulin secretion in individuals at high risk for type 2 diabetes. Diabetes. 2026;75(6):965-973. doi:10.2337/db25-0757
Cluster 5 participants had a larger increase of adjusted fasting plasma glucose by 0.5 mmol/L (p=0.05).
Cluster 5 participants showed a larger increase of adjusted 2-hour plasma glucose by 0.4 mmol/L (p=0.02).
Cluster 5 participants experienced a larger decrease in adjusted insulin secretion by -0.3 units (p=0.01).
Forty-one percent of cluster 5 participants developed type 2 diabetes.
Evidence network
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This study contributes evidence to Lifestyle intervention for prediabetes and 2-hour plasma glucose, Fasting Plasma Glucose (FPG), Insulin secretion levels after Roux-en-Y gastric bypass surgery, and 1 more.
This study contributes evidence to
Primary intervention
Lifestyle intervention for prediabetes
Primary outcomes
Intervention and outcome relationships this study adds to the evidence network.
Editorial context
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Evidence network role
This section describes how the study fits into the current evidence network. It does not determine whether an intervention works on its own.
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Contributes evidence
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Contributes evidence
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Contributes evidence
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Contributes evidence
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Primary evidence
Evidence topic
matched_intervention_and_outcome
Related evidence
Evidence topic
Save evidence
Core evidence
The primary outcomes reported in this study.
Lifestyle intervention for prediabetes → 2-hour plasma glucose
Lifestyle intervention for prediabetes → 2-hour plasma glucose
Lifestyle intervention for prediabetes → Fasting Plasma Glucose (FPG)
Lifestyle intervention for prediabetes → Fasting Plasma Glucose (FPG)
Lifestyle intervention for prediabetes → Insulin secretion levels after Roux-en-Y gastric bypass surgery
Lifestyle intervention for prediabetes → Insulin secretion levels after Roux-en-Y gastric bypass surgery
Lifestyle intervention for prediabetes → Type 2 diabetes incidence
Lifestyle intervention for prediabetes → Type 2 diabetes incidence
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Relationships organized using the Dediabetes Evidence Intelligence™ framework.
This study contributes to evidence on Lifestyle intervention for prediabetes and Diabetes Incidence and Prevention, Lifestyle intervention for prediabetes and Fasting Glucose.
This study contributes to the evidence on the following intervention-outcome relationships.
Behavioral & Lifestyle
Behavioral & Lifestyle
Curated evidence collections and hubs this study is part of.
All studies measuring Fasting Glucose
Measures Fasting Glucose as a key outcome.
All studies measuring Diabetes Incidence and Prevention
Measures Diabetes Incidence and Prevention as a key outcome.
All studies on Lifestyle intervention for prediabetes
Contributes to Lifestyle intervention for prediabetes evidence base.
Latest published studies
Published within the last 2 years.
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8 results
9 results
8 results
8 results
9 results
Generated from the study's connected evidence using Evidence Intelligence™.
Lifestyle intervention for prediabetes may reduce type 2 diabetes incidence.
ConsistencyScore™: Results are mixed and should be interpreted cautiously.
Ranked evidence signals
Type 2 diabetes incidence
EvidenceScore™ Strong | EvidenceScore™ 87.9 | moderate positive | ConsistencyScore™ Mixed | 1 study
Why this answer: This answer is cautious because the available studies report mixed findings.
Limitations
Lifestyle intervention for prediabetes may improve fasting plasma glucose (FPG).
ConsistencyScore™: Results are mixed and should be interpreted cautiously.
Ranked evidence signals
Fasting Plasma Glucose (FPG)
EvidenceScore™ Strong | EvidenceScore™ 87.1 | moderate positive | ConsistencyScore™ Mixed | 1 study
Why this answer: This answer is cautious because the available studies report mixed findings.
Limitations
Lifestyle intervention for prediabetes may improve 2-hour plasma glucose.
ConsistencyScore™: Results are generally consistent across studies.
Ranked evidence signals
2-hour plasma glucose
EvidenceScore™ Strong | EvidenceScore™ 82.3 | weak positive | ConsistencyScore™ Generally Consistent | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
Current evidence does not show a clear benefit of Lifestyle intervention for prediabetes for insulin secretion levels after roux-en-y gastric bypass surgery.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
Insulin secretion levels after Roux-en-Y gastric bypass surgery
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | neutral | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
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