Background: Diabetes mellitus is a global health problem causing premature death rather than individuals, families and societies economic burden. Aim: To determine the effect of protection motivation sustained integrated nursing intervention on type 2 diabetes mellitus risk among pre-diabetics. Subjects & Methods: Purposive sample of 250 pre diabetics matched to the inclusion criteria was selected. Setting: General medical department and diabetic out-patients' clinics at Menoufia University and Shebien El-kom Teaching hospitals. Tools: Four tools were utilized. I. Self-administered questionnaire II: Protection Motivation Theory questionnaire; III: Nutritional assessment sheet. IV: Diabetes mellitus modifiable risk assessment score. Design: A quasi-experimental with pre, posttest and follow up was utilized. Results: The mean age of studied pre-diabetics was 44 years, the percentage of good dietary health habits was improved from 18.4% in pre intervention to 39.6% in post intervention and reached to 51.6% in follow up. High statistically significant activity level improvement from 25.2% pre intervention to 42.4% post intervention with p <0.0001. Statistically significant reduction in cumulative blood glucose level among pre-diabetics in post intervention and follow up from 46% and 23 % respectively. Percentage of regular checkup of blood glucose increased from 2.4% to 39.6% then to 55.6% from pre to post then to follow up, respectively. Percentage of low risk pre-diabetics increased from 24% to 59.6% in post intervention and reached to 84% in follow up intervention with P value < 0.001. Conclusions: The protection motivation sustained integrated nursing intervention had been beneficial in decreasing total risk score of Diabetes mellitus among pre-diabetics , improving the disease related healthy behavior as consuming a healthy diet, being physically active, reducing their weight, cholesterol & cumulative glucose level and number of smoked cigarettes. Recommendation: Close monitoring, early detection and proper management of pre-diabetics should be carried out by each country-authorized personnel.