Reversing Prediabetes Cuts Cardiovascular Death and Heart Failure Risk by 58%, Landmark Analysis Reveals
Key Insights
A reanalysis of two major diabetes prevention studies found that prediabetes (search) remission was associated with a 58% lower risk of cardiovascular death or heart failure (search) hospitalization.
The findings challenge the assumption that lifestyle changes alone protect against heart disease in prediabetes (search), as earlier analyses showed no significant cardiovascular risk reduction from lifestyle interventions.
The protective benefit persisted for decades after blood glucose normalization, suggesting long-lasting effects of achieving prediabetes (search) remission.
A new analysis of two landmark diabetes prevention studies has found that individuals who reversed their prediabetes (search) and returned blood glucose levels to normal experienced a 58% lower risk of cardiovascular death or hospitalization for heart failure (search). The findings, published in The Lancet Diabetes & Endocrinology, point to prediabetes remission as a potentially powerful new target for preventing heart disease and improving long-term health outcomes.
The study challenges one of the biggest assumptions in modern preventative medicine: that lifestyle changes such as exercising more, losing weight, and improving diet protect people with prediabetes (search) from heart attacks and early death.
"This study challenges one of the biggest assumptions in modern preventative medicine. For years, people with prediabetes (search) have been told that losing weight, exercising more and eating healthier will protect them from heart attacks and early death. While these lifestyle changes are unquestionably valuable, the evidence does not support that they reduce heart attacks or mortality in people with prediabetes. Instead, we show that remission of prediabetes is associated with a clear reduction in fatal cardiac events, heart failure (search), and all-cause mortality," explained study lead author Dr. Andreas Birkenfeld, Reader in Diabetes, King's College London and University Hospital Tuebingen.
A Global Health Concern
Prediabetes (search) occurs when blood sugar levels are elevated but not high enough to meet the criteria for type 2 diabetes (search). Although many people with prediabetes eventually develop type 2 diabetes, the condition itself is linked to a higher risk of cardiovascular disease (search), one of the leading causes of death worldwide.
The condition is extremely common. About one in five adults in the United Kingdom has either diabetes or prediabetes (search). In the United States, more than one in three adults are affected, while in China the figure reaches four in ten. Researchers estimate that more than one billion people globally have prediabetes.
Long-Term Data from Two Continents
The research team, led by Dr. Birkenfeld, reexamined data from two major diabetes prevention studies: the US Diabetes Prevention Program Outcomes Study (DPPOS) and the Chinese DaQing Diabetes Prevention Outcomes Study (DaQingDPOS). Both studies tracked people with prediabetes (search) for decades and included interventions such as increased physical activity and healthier eating habits.
The analysis showed that participants who achieved remission of prediabetes (search) experienced a 58% lower risk of cardiovascular death or hospitalization for heart failure (search). The benefit remained evident decades after blood glucose levels returned to normal, suggesting that the effects of glucose normalization may be long lasting.
Additionally, people who reversed prediabetes (search) had a 42% lower risk of heart attack, stroke, and other major cardiovascular events. Importantly, the findings were consistent across both the US and Chinese study populations.
Why Remission Matters More Than Lifestyle Changes Alone
Earlier analyses of the same studies found that combined lifestyle interventions, including increased exercise and healthier diets, did not significantly reduce cardiovascular disease (search) risk. According to the researchers, this indicates that simply delaying the development of diabetes may not be enough to protect the heart. Meaningful metabolic improvements, such as achieving remission of prediabetes (search), may be necessary to produce substantial cardiovascular benefits.
"The study findings mean that prediabetes (search) remission could establish itself -- alongside lowering blood pressure, cutting cholesterol and stopping smoking -- as a fourth major primary prevention tool that truly prevents heart attacks and deaths," added Dr. Birkenfeld.
Practical Approaches to Achieving Remission
Experts emphasize that prediabetes (search) reversal is achievable through targeted interventions. Kardie Tobb, DO, MS, FASPC, FACC, a board-certified preventive cardiologist and medical director for the Cone Health HeartCare Women's Heart Health and Cardio-Obstetrics Clinic, notes that even one exercise session makes cells more sensitive to insulin. "This is the closest thing to a magic pill we have," she said, recommending 30 minutes of daily exercise five days a week, with walking for 10 to 15 minutes after meals as an accessible starting point.
Dietary strategies include filling half the plate with non-starchy vegetables, a quarter with protein sources, and a quarter with whole grains or starchy vegetables, while eliminating sugary drinks. Weight loss of just five to seven percent of body weight can make a beneficial difference, with some patients seeing their A1C drop back to normal after losing just 10 pounds.
The timeline for reversal varies. "The shortest turnaround I've witnessed was about six weeks," said Dr. Tobb, describing a patient in his early 40s whose fasting blood sugar dropped from 118 to 94 mg/dL after cutting sugary beverages and walking 30 minutes after dinner. Full reversal typically takes between three and 12 months.
International Research Collaboration
The study is part of the transCampus partnership, a long-running collaboration between King's College London and TUD Dresden University of Technology (search). Professor Stefan Bornstein, Dean of transCampus, described the partnership as "a unique partnership established by King's College London and the TUD Dresden University of Technology as a transnational strategic partnership based on the idea of true cooperation and an intense dedication for collaboration in all fields."