Prediabetes Remission Through Lifestyle Changes Cuts Cardiovascular Risk: Study
A new study published in the journal of The Lancet Diabetes & Endocrinology showed that the risk of heart failure, myocardial infarction, and early mortality can be cut in half with lifestyle modifications that result in prediabetes remission.
Multicomponent lifestyle therapies like diet and exercise aimed at weight loss, are advised for the management of prediabetes. It has been demonstrated that achieving prediabetes remission by the restoration of normal glucose control significantly lowers the risk of type 2 diabetes in the future, outlasting the duration of lifestyle intervention. This study sought to determine if prediabetes remission is linked to a decreased incidence of cardiovascular mortality or hospitalization for heart failure, with a potential long-term residual effect.
Two important diabetes prevention studies, the Chinese DaQing Diabetes Prevention Outcomes Study (DaQingDPOS) and the US Diabetes Prevention Program Outcomes Study (DPPOS), were subjected to post-hoc analysis. After one year (DPPOS) or six years (DaQingDPOS) of treatments, remission was evaluated using the American Diabetes Association criteria.
Cardiovascular mortality or hospitalization for heart failure over 20 or 30 years, respectively, was the main outcome. Inverse probability of treatment weighting was used in DPPOS to account for baseline variations. For the main endpoint and all-cause mortality, a unifying meta-analysis was computed for both data sets.
The follow-up period for DPPOS is provided from July 31, 1996, the beginning of the first Diabetes Prevention Program study, until February 23, 2020, the conclusion of DPPOS phase 3. There were 540 participants in DaQingDPOS and 2402 in DPPOS. After a year of intervention, 275 (11·5%) of 2402 patients in DPPOS achieved remission, whereas 2127 (88·5%) of 2402 did not.
The event rate for cardiovascular death or heart failure hospitalization in DPPOS was 1·74 (95% CI 0·87–3·48) per 1000 person-years in participants who achieved remission, compared to 4·17 (95% CI 3·55–4·89) in those who did not (p=0·013), with a fully adjusted hazard ratio of 0·41 (95% CI 0·20–0·84; p=0·014).
A pooled meta-analysis corroborated the results, which remained strong after adjustment and were validated in DaQingDPOS (primary endpoint: HR 0·49 [95% CI 0·28–0·84]; p=0·010). When examining the composite endpoint in individuals who had remission at least once during follow-up, the results were consistent, with an HR of 0·43 (0·29–0·63; p<0·0001). Overall, in DPPOS and DaQingDPOS, remission of prediabetes to normal glucose control is associated with a decreased risk of cardiovascular death, hospitalization for heart failure, and all-cause mortality.
Source:
Vazquez Arreola, E., Gong, Q., Hanson, R. L., Wang, J., Sandforth, L., He, S., Sandforth, A., Qian, X., Giacca, M., Bornstein, S. R., Fritsche, A., Stefan, N., Preissl, H., Gregg, E. W., Marx, N., Jumpertz-von Schwartzenberg, R., Li, G., & Birkenfeld, A. L. (2025). Prediabetes remission and cardiovascular morbidity and mortality: post-hoc analyses from the Diabetes Prevention Program Outcome study and the DaQing Diabetes Prevention Outcome study. The Lancet. Diabetes & Endocrinology. https://doi.org/10.1016/S2213-8587(25)00295-5
