A new study has published in theBMC Chinese Medicinefound that the use of Traditional Chinese Medicine (TCM) was associated with a reduced incidence of type 2 diabetes mellitus (T2DM) among individuals with prediabetes in the study population. Prediabetes has long been a critical intervention window in diabetes prevention. Although TCM has been used for centuries to manage blood glucose, robust modern data on its long-term effectiveness in preventing diabetes has been limited, until now. This research used data from the Yinzhou Regional Health Care Database (YRHCD), this long-term population-based cohort study offered strong evidence supporting the potential of TCM as an effective preventive approach against diabetes progression. The research analyzed a total of 14,164 individuals with prediabetes from the YRHCD between 2009 and 2024. Of these, 12,252 participants were TCM users, while 1,912 received western medications (WM) commonly prescribed for blood glucose control. This research applied a Cox proportional hazards model with propensity score matching (PSM) to minimize bias and balance demographic and clinical differences between the groups. The study revealed that among TCM users, the incidence of T2DM was 33.95 per 1,000 person-years, when compared to 94.85 per 1,000 person-years among those treated with western medications. This translates to nearly a 3-fold reduction in diabetes risk for TCM users. After controlling for potential confounding factors through PSM, TCM use was associated with a 68% lower risk of developing T2DM (Hazard Ratio 0.32; 95% Confidence Interval 0.27–0.38). The findings remained consistent across multiple subgroup and sensitivity analyses, which reinforced the reliability of the results. Overall, this study suggest that TCM use was strongly associated with a lower incidence of T2DM among prediabetic individuals. These findings highlight the potential role of TCM as an effective, long-term preventive strategy for delaying or even halting diabetes onset. Further studies, particularly randomized controlled trials, are imperative to validate these results and explore the mechanisms underlying TCM’s protective effects against diabetes progression. Long, Z., Zhao, H., Yin, Y., Sun, Y., Shen, P., Lin, H., Liu, J., Zhan, S., Jiang, Z., & Sun, F. (2025). Traditional Chinese medicine use and risk of type 2 diabetes mellitus among patients with prediabetes: a population-based cohort study. Chinese Medicine, 20(1), 171.https://doi.org/10.1186/s13020-025-01214-x