About 1 in 4 people with prediabetes will develop type 2 diabetes over 3-5 years. We also know that not only diabetes, but also prediabetes, is associated with an increased risk of cardiovascular events (eg heart attacks). Yet, there is often clinical inertia in the prediabetes zone – ‘let’s just keep an eye on this’ – rather than addressing it head on.

In people with type 2 diabetes, good blood sugar control now can reduce risk of cardiovascular events years later – this is what we call the ‘legacy effect’. Part of the inertia in treating prediabetes (to bring sugars into the normal, non-diabetes range) is because the legacy effect hadn’t been demonstrated in prediabetes – until now.

A new publication in The Lancet Diabetes & Endocrinology examined whether putting prediabetes into remission with lifestyle changes could reduce long-term cardiovascular event risk. This post-hoc analysis examined data from participants in two landmark diabetes prevention trials with lifestyle interventions, The Diabetes Prevention Program Outcomes Study (DPPOS) and the DaQing Diabetes Prevention Outcome Study. In DPPOS participants, the risk of cardiovascular death or hospitalization for heart failure was reduced by 59% over 20 years, in those who were in remission from prediabetes at 1 year. In DaQing, the risk was reduced by 51% over 30 years, in those who were in remission from prediabetes at 6 years. The pooled reduction in risk over 20-30 years was 53%, and the pooled reduction in risk of death (all-cause mortality) was 37%.

These data remind us that health risk associated with normal sugars vs prediabetes vs diabetes should not be dichotomized; rather, there is a continuum of blood sugars associated with progressive increase in health risk (similar to how we think about blood pressure or cholesterol levels).

These data also remind us of the importance of : Treat, Treat Early, and Treat Long Term! Remembering that prediabetes and type 2 diabetes are associated with excess body fat in most cases, we need to address and treat both glucose and elevated weight earlier, to disrupt the natural progression of these metabolic health issues, helping people lead longer, healthier lives.

It’s important to point out that there are medications that reduce cardiovascular event risk in people with type 2 diabetes (GLP1-based medications and SGLT2 inhibitors), and in people with obesity with normal sugars or prediabetes [semaglutide (Wegovy)], while simultaneously providing a host of additional health benefits.

BOTTOM LINE: Remission of prediabetes (normalization of blood sugars) with lifestyle changes halves the risk of of cardiovascular event or hospitalization for heart faiure, and reduces the risk of death from any cause by over a third, 20-30 years later. It’s high time that prediabetes is no longer considered as a ‘wait and see’ scenario, and rather, a potent opportunity to holistically improve health and lifespan.

Disclaimer: I am/have been an investigator in clinical trials of many GLP-1 and SGLT2 inhibitor medications, including semaglutide (Wegovy). I receive honoraria as a continuing medical education speaker and consultant from the makers of several of these manufacturers, including makers of semaglutide (Novo Nordisk).

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