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Type 2 diabetes (T2D) is a major threat to human health worldwide. Despite the enormous potential in addressing the root cause of the problem by early lifestyle intervention, which counteracts disease progression, high-risk individuals rarely receive structured lifestyle support. A major reason is that prevention programs require large resources. Clinical guidelines therefore emphasize the need for new scalable prevention such as digital tools. There are however severe knowledge gaps in long-term efficacy data and cost-effectiveness. To address the large unmet need for more effective prevention, we will study the outcomes of a nation-wide randomized trial with a new digital lifestyle intervention. This intervention has recently been shown to improve metabolic outcomes over several years in patients with manifest T2D. Here we will study its efficacy on T2D prevention in 90,000 individuals. The project goes considerably beyond previous research, also in international comparison, by the innovative intervention, the large study size with rigorous incidence measures and pioneering analyses of pathophysiological subgroups. We will also investigate cost-effectiveness and utilize our network of collaborating healthcare regions and companies to study Social Outcomes Contracts as a future model to effectively implement preventive interventions in society. By its inter-disciplinary strategy, the project may have vast impact on patients, healthcare and society at large.