New research from King’s College London finds that bringing blood sugar back to normal in people with prediabetes can slash the risk of fatal heart problems. The work could reshape how doctors worldwide prevent heart disease in more than a billion people.
Lowering blood sugar to normal levels in people with prediabetes can cut their risk of serious, potentially deadly heart problems by more than half, according to new research from King’s College London.
The study, published in The Lancet Diabetes & Endocrinology, suggests that reversing prediabetes — not just delaying the onset of type 2 diabetes — is strongly linked to fewer fatal heart events, fewer hospitalizations for heart failure and lower risk of death from any cause.
Researchers say the findings could change how doctors think about preventing heart disease in the more than 1 billion people worldwide who are estimated to have prediabetes.
Prediabetes is a condition in which blood sugar levels are higher than normal but not yet high enough for a type 2 diabetes diagnosis. It often progresses to type 2 diabetes, but even before that point, it raises the risk of cardiovascular disease, one of the world’s leading causes of death.
In the UK, about one in five adults has diabetes or prediabetes. In the United States, the figure is more than one in three, and in China it is about four in 10. That makes prediabetes a massive global health issue — and a major opportunity for prevention.
The new analysis, led by Andreas Birkenfeld, a reader in diabetes at King’s of King’s College London and University Hospital Tuebingen, revisited data from two landmark diabetes prevention trials: the U.S. Diabetes Prevention Program Outcomes Study (DPPOS) and the Chinese DaQing Diabetes Prevention Outcomes Study (DaQingDPOS).
Both long-running studies followed people with prediabetes for decades and tested lifestyle interventions such as increased exercise and healthier eating. Earlier analyses had shown that these lifestyle programs delayed the onset of type 2 diabetes but did not clearly reduce cardiovascular disease.
That raised a troubling question: If lifestyle changes help postpone diabetes but do not lower heart risk, what actually protects the heart?
By reanalyzing the data, Birkenfeld’s team focused not just on whether diabetes was delayed, but on whether people’s blood sugar returned fully to normal — a state the researchers describe as remission of prediabetes.
They found that people who achieved remission had a 58% lower risk of dying from cardiovascular causes or being hospitalized for heart failure compared with those who did not. This benefit persisted for decades after blood sugar levels were normalized, suggesting a lasting impact from getting glucose under control.
The study also found that the risk of heart attack, stroke and other major cardiovascular events was reduced by 42% in those who achieved remission. The pattern was similar in both the U.S. and Chinese groups, despite differences in health systems, diets and cultures.
Birkenfeld said the findings overturn a widely held belief in preventive medicine.
“This study challenges one of the biggest assumptions in modern preventative medicine. For years, people with prediabetes have been told that losing weight, exercising more and eating healthier will protect them from heart attacks and early death,” she said in a news release. “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, and all-cause mortality.”
In other words, simply slowing the march toward diabetes is not enough to guarantee heart protection. What seems to matter most is actually restoring blood sugar to normal and maintaining that improvement.
That distinction could have major implications for how doctors screen and treat people with prediabetes. Today, many are advised to make lifestyle changes and then wait to see whether they eventually develop diabetes. The new findings suggest that clinicians may need to aim more aggressively for full normalization of blood sugar as a specific treatment goal.
Birkenfeld said the results elevate prediabetes remission to the same level as other cornerstone strategies for preventing heart disease.
“The study findings mean that prediabetes 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,” she said.
The research does not spell out exactly which treatments or combinations of approaches are best for achieving remission in prediabetes. In practice, that could include tailored diet and exercise programs, weight management, medications that improve insulin sensitivity, or other emerging therapies. Future studies will be needed to test which strategies work best, for whom and at what stage.
Still, the message is clear: For people with prediabetes, there is a window of opportunity to dramatically reduce the risk of serious heart problems by bringing blood sugar back into the normal range.
The work also highlights the power of international collaboration. The study is part of a long-standing partnership between King’s College London and TUD Dresden University of Technology, known as the transCampus.
For patients and clinicians, the findings offer both a warning and a source of hope. Prediabetes is common and serious, but it is also a stage at which decisive action can pay off for decades.
As health systems around the world grapple with rising rates of diabetes and heart disease, targeting prediabetes remission could become a powerful new way to save lives.
Source: King’s College London