An international analysis has proven for the first time that people with prediabetes can reduce their risk of heart attack, heart failure and premature death by half if they bring their blood glucose levels back into the normal range through lifestyle changes. This finding could fundamentally change prevention strategies and introduce a new, measurable goal in medical guidelines. Researchers from the University Hospital Tübingen, Helmholtz Munich and the German Center for Diabetes Research (DZD) were involved in the study.

Millions of people in Germany suffer from elevated blood glucose levels unnoticed and are therefore considered prediabetic. This condition represents an early stage of diabetes for which no clear therapeutic goals have been defined so far. Those affected usually receive advice on how to lose weight, do more physical activity and eat healthier. Such measures improve physical condition, well-being and various risk factors. Until now, however, it remained unclear whether they protect the heart in the long term. No lifestyle program for prediabetics has been able to prove that it sustainably reduces heart attacks, heart failure or cardiovascular deaths over decades.

The new study evaluated data from two of the largest diabetes prevention studies worldwide, one from the USA and one from China. In collaboration with colleagues from these countries, the German researchers analyzed long-term data from more than 2400 people with prediabetes. The results show that it is not the lifestyle change alone that is decisive, but whether it is possible to normalize blood glucose levels and thus achieve remission of prediabetes.

In the participants who successfully lowered their blood sugar, the risk of cardiovascular death decreased by about 50 percent. Overall mortality also decreased significantly. The U.S. study, known as the Diabetes Prevention Program Outcomes Study (DPPOS), followed the subjects for 20 years. The Chinese Da-Qing study even spanned 30 years. The Tübingen team harmonized these datasets and compared the rates of cardiovascular death and hospitalizations for heart failure between groups with and without remission.

It is noteworthy that the protective effect occurs independently of weight loss. Even if both groups lost a similar amount of weight, only those with normalized glucose levels benefited from the risk reduction. A fasting blood glucose level of 97 milligrams per deciliter or lower proved to be a reliable marker of a permanently lower heart risk. This value applies regardless of age, body weight or ethnic origin and could be used in GP practices worldwide to make prevention more concrete.

So far, cardiovascular prevention has been based on three pillars: controlling blood pressure, lowering LDL cholesterol and giving up smoking. The new data suggest that a fourth pillar could be added: the long-term normalization of blood sugar in prediabetes. Remission not only delays the onset of type 2 diabetes, but also protects against severe cardiovascular disease for decades.

The study highlights a therapeutic window: early normalization of glucose levels in the prediabetes stage can significantly reduce the long-term risk of heart attack, heart failure and premature death. The researchers advocate anchoring remission as a primary goal in guidelines for the prevention of diabetes and cardiovascular disease.

In an international comparison, Germany performs poorly in preventive health care. According to the latest Public Health Index, the country ranks second to last among 18 European countries in the implementation of evidence-based prevention measures. As a result, the risk of dying from cardiovascular disease is significantly higher in Germany than in many neighboring countries.

The findings of the study reveal untapped potential. Concrete targets such as glucose normalization could improve public health and help millions of sufferers. The original publication appeared in the journal The Lancet Diabetes & Endocrinology. Institutions such as the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen as well as partners in Düsseldorf, Potsdam-Rehbrücke, Dresden and other locations were involved.

The University Hospital Tübingen, founded in 1805, is one of the leading centers of university medicine in Germany and combines high-performance medicine with research and teaching. Every year, more than 400,000 patients benefit from interdisciplinary expertise in areas such as diabetology, neuroscience and oncology. Helmholtz Munich focuses on biomedical research on diseases such as diabetes and obesity. The DZD brings together experts from basic research, epidemiology, and clinical practice to develop personalized strategies against diabetes.

This study thus marks a breakthrough that elevates the treatment of prediabetes from a general recommendation to a targeted approach. Early interventions could not only prevent the outbreak of diabetes, but also reduce the burden of cardiovascular disease on the health system. Experts see this as an opportunity to make prevention more tangible and effective, especially in countries with high prediabetes rates such as Germany.

Original Paper:

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

Editor: X-Press Journalistenbüro GbR

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