New Research Challenges Long-Held Assumptions About Prediabetes Treatment

Achieving remission from prediabetes dramatically reduces the risk of heart disease and other major cardiovascular events.

Lowering blood sugar levels dramatically reduces the risk of serious heart problems in people with prediabetes.

Research from King’s College London, published in The Lancet Diabetes & Endocrinology, shows that restoring blood glucose levels to a normal range, effectively reversing prediabetes, reduces the risk of death from heart disease or hospital admission for heart failure by more than 50%.

Prediabetes remission sharply cuts heart risk

The finding stands out because earlier research suggested that lifestyle changes alone, including exercise, weight loss, and healthier diets, do not significantly reduce cardiovascular risk in people with prediabetes.

Together, these findings point to a potentially life-saving goal for people living with the condition. Achieving remission of prediabetes could become a key strategy for preventing cardiovascular disease and may signal an important shift in how clinicians approach treatment.

“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. 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.” – Study lead author Dr. Andreas Birkenfeld, Reader in Diabetes, King’s College London and University Hospital Tuebingen

Prediabetes affects over a billion people

Prediabetes occurs when blood glucose levels rise above normal but remain below the threshold for type 2 diabetes. Although the condition often progresses to diabetes, it is also linked to a higher risk of cardiovascular disease, one of the leading causes of death worldwide.

In the UK, roughly one in five adults lives with diabetes or prediabetes. In the United States, the proportion exceeds one in three, while in China it reaches four in ten. Worldwide, more than one billion people are estimated to have prediabetes.

Decades of trials reveal lasting benefit

Led by Dr. Andreas Birkenfeld from King’s College London and University Hospital Tuebingen, the research 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 long-term investigations followed individuals with prediabetes for several decades and included interventions such as increased physical activity and healthier diets.

Participants who achieved remission from prediabetes experienced a 58% lower risk of cardiovascular death or hospital admission due to heart failure. The protective effect remained visible decades after blood glucose levels returned to normal, suggesting that controlling glucose can produce long-lasting health benefits.

Researchers also reported that the risk of heart attack, stroke, and other major adverse cardiovascular events fell by 42% among individuals who achieved remission.

These findings were consistent across both the Chinese and US datasets.

Earlier analyses of the same studies had shown that combined lifestyle interventions, including more exercise and healthier diets, did not reduce cardiovascular disease on their own. This indicates that delaying the onset of diabetes may not be enough to protect the heart unless key metabolic changes take place.

“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,” added Dr. Birkenfeld.

A long term international research partnership

The work forms part of a long-standing collaboration between King’s College London and TUD Dresden University of Technology known as the transCampus.

“The transCampus is 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. Guided by shared ideas, values, and a devotion to research and education, transCampus enables researchers to work together beyond the means of a traditional partnership by sharing resources, combining their strength, and promoting transnational projects and knowledge transfer.” – Professor Stefan Bornstein, Dean of transCampus

Reference: “Prediabetes remission and cardiovascular morbidity and mortality: post-hoc analyses from the Diabetes Prevention Program Outcome study and the DaQing Diabetes Prevention Outcome study” by Elsa Vazquez Arreola, Qiuhong Gong, Robert L Hanson, Jinping Wang, Leontine Sandforth, Siyao He, Arvid Sandforth, Xin Qian, Mauro Giacca, Stefan R Bornstein, Andreas Fritsche, Norbert Stefan, Hubert Preissl, Edward W Gregg, Nikolaus Marx, Reiner Jumpertz-von Schwartzenberg, Guangwei Li and Andreas L Birkenfeld, 12 December 2025, The Lancet Diabetes & Endocrinology.
DOI: 10.1016/S2213-8587(25)00295-5

Funding: German Center for Diabetes Research via the German Federal Ministry of Research, Technology and Space; Ministry of Science, Research, and the Arts Baden-Württemberg; Helmholtz Munich; the Helmholtz Young Investigators Groups funding programme; the Cluster of Excellence EXC-2124; and the German Research Foundation (DFG). For DaQing: Centers for Disease Control and Prevention, WHO, the China-Japan Friendship Hospital, and Da Qing First Hospital and Fuwai Hospital, Chinese Academy of Medical Sciences. For DPPOS: National Institute of Diabetes and Digestive and Kidney Diseases.

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