Getting blood sugar levels back to normal if you have prediabetes could cut your risk of a fatal heart attack or hospitalization for heart failure by more than half, according to new research from King's College London published in The Lancet Diabetes & Endocrinology.
The finding upends conventional wisdom about how to protect the heart in people with elevated blood sugar. For years, doctors have told prediabetic patients that weight loss, exercise, and better diet would shield them from cardiovascular catastrophe. The evidence, it turns out, does not support that claim.
"This study challenges one of the biggest assumptions in modern preventative medicine," said Dr. Andreas Birkenfeld, the study's lead author from King's College London. "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."
Researchers analyzed decades of data from two major prevention trials: the US Diabetes Prevention Program Outcomes Study and the Chinese DaQing Diabetes Prevention Outcomes Study. Both tracked thousands of people with prediabetes over many years.
The results were striking. People who achieved prediabetes remission experienced a 58 percent lower risk of dying from heart disease or being hospitalized for heart failure. They also had a 42 percent lower risk of heart attack, stroke, and other major cardiovascular events. The benefits persisted for decades after blood glucose levels normalized, suggesting the effects endured long term.
The scale of the problem is enormous. More than one billion people globally have prediabetes, a condition where blood sugar is elevated but not high enough to qualify as type 2 diabetes. In the UK, one in five adults has either diabetes or prediabetes. The US figure reaches one in three. In China, the rate climbs to four in ten.
Why would normalizing blood sugar matter more than the lifestyle interventions themselves? The researchers suggest that simply delaying diabetes development may not be enough to guard the heart. Achieving actual metabolic improvement and prediabetes remission appears necessary to deliver substantial cardiovascular protection.
Birkenfeld framed the implications bluntly: "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."
The gap between lifestyle changes and glucose normalization matters for clinical practice. It suggests doctors may need to focus less on whether patients exercise and eat better, and more on whether their blood sugar actually returns to normal. That shift could reshape how prediabetes is treated and monitored across millions of patients worldwide.
Author Jessica Williams: "If this holds up, it rewrites the playbook for preventing heart disease in prediabetic patients, and it means simply telling people to diet and exercise isn't enough."
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