Dec 18, 2025
3 min read
When people with prediabetes get their blood glucose levels back to normal through lifestyle changes, the risk of heart attack, heart failure and premature death can be cut in half, an international review shows.
Exercise, diet changes and weight loss: When people with prediabetes return their blood glucose levels to normal through lifestyle changes, their risk of heart attack, heart failure and premature death is halved.This is shown by the results of an international study published in The Lancet Diabetes & Endocrinology, which analyzed long-term data from 2,402 people with prediabetes [1].
This is a pooled analysis of 2 of the world's largest diabetes prevention studies - from the United States (Diabetes Prevention Program Derivatives Study, DPPOS) and from China (Diabetes Prevention Outcomes Study, DAQINGDPOS).Researchers from Tübingen University Hospital, Helmholtz Munich and the German Diabetes Research Center (DZD) were involved in the study.
Millions of people in Germany live with high blood glucose levels without knowing it.They are considered "prediabetic" - an early stage that has so far remained without a clearly defined treatment goal.As the results of the analysis show, the decisive factor is not the change in lifestyle itself, but whether people with prediabetes manage to return to the normal range of blood glucose, that is, whether they achieve remission of prediabetes.In both studies, the risk of cardiovascular death was about 50% lower for participants who were able to put their prediabetes into remission, and overall mortality also dropped significantly.
The American DPPOS study followed its experimental subjects for 20 years, and its Chinese counterpart DaQingDPOS for more than 30 years.Led by the Tübingen team, this data set was adjusted and re-evaluated to compare rates of cardiovascular death and heart failure hospitalizations in people with and without prediabetic remission.
In the DPPOS study, 275 (11.5%) of 2,402 participants achieved remission after one year of intervention, compared to 2,127 (88.5%) of 2,402 who did not.In the DPPOS, the event rate for cardiovascular disease or hospitalization due to heart failure was 1.74 (95% confidence interval [CI] 0.87-3.48) per 1,000 person-years among participants who achieved remission compared with 4.17 (95% CI 3.55-4.89) among those who did not achieve remission.0.000.(p = 0.014).The results were confirmed in DaQingDPOS (primary endpoint: hazard ratio [HR] 0.49; p = 0.010) and supported by a pooled meta-analysis.
Normal blood sugar as a new target for cardiovascular prevention
Until now, the prevention of the cardiovascular system has been based on 3 pillars: blood pressure control, reduction of LDL cholesterol and smoking cessation.With the new findings, a fourth pillar can be added: normalizing blood sugar levels in diabetes.
"Our results indicate that remission of prediabetes not only delays or prevents the onset of type 2 diabetes - as is already known - but also protects people from serious cardiovascular diseases in the long term - for decades," says the head of the study, Prof. Dr.Andreas Birkenfeld, member of the board of DZD and medical director IV.medical clinic of the University Hospital in Tübingen.
Studies have found that a fasting blood sugar level ≤ 97 mg/dl is a simple marker of permanently reduced risk of heart disease – regardless of age, weight or race. This threshold can be used in general practice around the world, making prevention more practical.
Germany lags behind when it comes to prevention: According to the current Public Health Index, the country ranks second among 18 European countries in implementing science-based prevention measures.As a result, the risk of dying from cardiovascular diseases in Germany is high compared to other European countries.
If glucose levels in the prediabetes phase are normalized, the long-term risk of heart attack, heart failure and premature death can be significantly reduced.
Professor Andreas Birkenfeld, Ph.D.
New study shows untapped potential and how specific target values could significantly improve public health."We see a clear therapeutic window: If glucose levels are normalized in the early stages of diabetes, the risk of heart disease, heart failure, and early death is significantly reduced," Birkenfeld said.
