The study found that reversing prediabetes by normalizing blood glucose levels was associated with more than a 50% reduction in the risk of dying from cardiovascular disease or being hospitalized for heart failure.

The findings are particularly noteworthy because recent research has suggested that lifestyle changes alone, such as exercising more, losing weight, and improving diet, do not appear to reduce cardiovascular risk in people with prediabetes.

Taken together, the results point to prediabetes remission as a potentially powerful new target for preventing heart disease and improving long-term health outcomes. The findings could also influence how doctors approach treatment for people with prediabetes.

"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," explained study lead author Dr. Andreas Birkenfeld, Reader in Diabetes, King's College London and University Hospital Tuebingen.

Prediabetes Affects More Than One Billion People Worldwide

Prediabetes occurs when blood sugar levels are elevated but not high enough to meet the criteria for type 2 diabetes. Although many people with prediabetes eventually develop type 2 diabetes, the condition itself is also linked to a higher risk of cardiovascular disease, 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. 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 Studies Reveal Lasting Heart Benefits

The research team, led by Dr. Andreas Birkenfeld of King's College London and University Hospital Tuebingen, 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 for decades and included interventions such as increased physical activity and healthier eating habits.

Researchers found that participants who achieved remission of prediabetes experienced a 58% lower risk of cardiovascular death or hospitalization for heart failure. The benefit remained evident decades after blood glucose levels returned to normal, suggesting that the effects of glucose normalization may be long lasting.

The analysis also showed that people who reversed prediabetes 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 Prediabetes Remission May Matter 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 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, may be necessary to produce substantial cardiovascular benefits.

"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.

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.

"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," said Professor Stefan Bornstein, Dean of transCampus.