t is unclear whether lifestyle interventions (LI) are effective in reducing risk of pre-diabetes (DM) among high risk adults with normal glucose levels (NGL). We conducted a systematic review to assess the effectiveness of LI to change glycemic indicators (GI) among adults (age ≥ 18 years) with NGL but with other DM risk factors. We identified randomized controlled trials with a follow-up interval ≥ 6 months published before April 2013 that examined LI, including physical activity (PA), dietary (D), behavioral (B) interventions, or their combinations. A random-effect model was used in pooling intervention effects. We identified 165 studies with 57318 participants. Results are summarized in Table 1. Pooled effects for PA, D, PA+D, and PA+D+B interventions compared to usual care showed significant decreases in fasting glucose (FG), fasting insulin (FI), and body weight (p<0.05 for each). PA and D combined interventions also improved A1 C levels significantly (-0.08[-0.13, -0.02]). Interventions with a D component had a stronger effect on weight than PAonly interventions; however, intervention effects on FG and FI were similar across different intervention modalities. In adults with NGL, PA, D, B interventions or their combinations can achieve significant improvements in weight, FG, and FI, thus reduce risk of progression to pre-DM. (Table Presented).