Millions of people in the United States are living with elevated blood sugar levels, a condition known as prediabetes, and may not even realize it.
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Not only are they in danger of developing diabetes, they are also at increased risk of heart disease.
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New research published in the medical journal The Lancet has found just how powerful achieving normal blood sugar through diet and exercise can be at reducing the odds of heart complications.
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“It’s the first international analysis to show that when people with prediabetes bring blood glucose back into the normal range, their long-term risk of heart attack, heart failure, and premature death is about cut in half,” says Andreas L. Birkenfeld, MD, lead study author and professor in the department of diabetology, endocrinology, and nephrology at University Hospital Tübingen in Germany.
“What this adds to the field is a shift from ‘we encourage lifestyle change’ to ‘we can aim for a measurable remission target,’” he says.
Heart Health Risks Cut in Half by Achieving Prediabetes Remission
In a joint analysis from two large diabetes prevention studies in the United States and China, Dr. Birkenfeld and a team of researchers set out to analyze whether lifestyle adjustments in people with prediabetes also helped protect heart health in the long-term.
Using data from more than 2,400 participants with prediabetes, researchers tracked participants in the United States for 20 years and in China for 30 years.
They found that those who successfully normalized their blood sugar levels through diet, exercise, or a combination of both reduced their risk of dying from heart disease by roughly 50 percent, compared with those whose blood sugar levels remained elevated. In addition, the group that achieved normal blood sugar levels had a significantly lower risk of being hospitalized for heart failure than the group that didn’t bring their blood sugar levels to a normal range.
“The practical takeaway is: Even slightly high blood sugar levels can translate to significant risk of cardiovascular disease or heart failure,” says Scott D. Isaacs, MD, president of the American Association of Clinical Endocrinology and medical director at Atlanta Endocrine Associates in Georgia. “Knowing your exact numbers and working with your doctor to normalize glucose is the best way to reduce risk.”
What Is Prediabetes, and Can You Reverse It?
Prediabetes is defined as having blood sugar levels that are higher than normal, but not high enough to be diagnosed with diabetes.
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It often goes unnoticed because most people have no obvious symptoms, Birkenfeld says. “Ocasionally some people may notice signs like darkened skin in certain areas, but screening [during a medical checkup] is really how it’s usually found,” he explains.
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Healthcare practitioners strive to help patients achieve prediabetes remission by getting blood sugar levels back down to a normal range — typically between 70 and 99 milligrams per deciliter (mg/dL) when fasting.
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As Isaacs points out, prediabetes is reversible for many people with an intensive lifestyle intervention program that aims to reduce progression to type 2 diabetes.
“The most effective strategies, based on the original U.S. Diabetes Prevention Program (DPP), are a structured weight reduction of about 7 percent of initial body weight through nutrition counseling and calorie reduction; at least 150 minutes per week of moderate-intensity physical activity such as brisk walking; and ongoing behavioral support and coaching to help people maintain these lifestyle changes over time,” he says.
A Potential New, Measurable Target for Health Disease Prevention
According to the research team, the new findings could help make prediabetes prevention a clear goal with remission as its aim.
“I’d emphasize the mindset shift,” Andreas says. “Prediabetes care shouldn’t be framed only as ‘Try not to get diabetes.’ Our data support anchoring remission as a primary treatment goal — because it’s measurable, motivating, and tied to outcomes people care about: avoiding major cardiovascular disease and living longer.”
The research analysis, which relies on data from two earlier trials, has some limitations. This kind of study, for instance, can’t firmly establish a cause-and-effect relationship between normalized blood sugar levels and reduced heart disease risk. “People who achieved prediabetes remission could differ in unmeasured ways — such as motivation, comorbidities, access to care — from those who did not,” Isaacs says.
But the findings are promising, and the research team is currently looking into follow-up studies to better understand which patients benefit the most from which prediabetes remission tactics — whether diet quality, weight loss, physical activity, or specific combinations.
“If remission cannot be achieved with lifestyle measures alone, our findings also raise the question of whether additional tools, including medication, should be considered for some individuals,” Birkenfeld says.
