- In long running trial follow ups, people who returned from prediabetes to normal glucose had much lower heart related risk
- Remission was linked with a 58% lower risk of cardiovascular death or hospital admission for heart failure and a 42% lower risk of major events
- The finding shifts attention from delay alone to true remission, but it is still based on reanalysis and not a new trial
Prediabetes is often framed as a warning stage on the road to type 2 diabetes, but it is also tied to cardiovascular disease.
New analysis from King’s College London argues that the key target may not simply be slowing progression, but actually returning blood glucose to a normal range.
The research, published in The Lancet Diabetes and Endocrinology, reanalysed data from two major diabetes prevention studies with decades of follow up: the US Diabetes Prevention Program Outcomes Study and the Chinese DaQing Diabetes Prevention Outcomes Study.
Both trials followed people with prediabetes over many years after lifestyle focused interventions, tracking long term outcomes including cardiovascular events and death.
The researchers found that people who achieved remission from prediabetes had far better outcomes later on.
- Sudden cardiac death risk dramatically higher in type 1 and type 2 diabetes
- People with type 2 diabetes produce less energy from ketone bodies
- Lower LDL cholesterol is linked with a higher chance of developing type 2 diabetes
Prediabetes remission was linked with a 58% lower risk of cardiovascular death or hospital admission for heart failure.
It was also associated with a 42% lower risk of heart attack, stroke and other major adverse cardiovascular events.
The effect appeared to persist long after glucose levels had normalised, suggesting something lasting about restoring healthier glucose regulation.
A crucial point in the write up is that earlier analyses of these trials suggested lifestyle programmes, while beneficial for health in many ways, did not reduce cardiovascular outcomes across the whole prediabetes population.
This new analysis argues the benefit shows up most clearly in the group that reached remission, not simply in those who took part in lifestyle change.
That does not mean lifestyle changes are pointless.
Weight loss, physical activity and healthier eating improve many aspects of health.
The point is narrower: cardiovascular protection in prediabetes may depend on achieving remission, not just reducing risk on paper or delaying diabetes diagnosis.
The authors suggest prediabetes remission could sit alongside blood pressure control, cholesterol reduction and smoking cessation as a major lever for preventing heart attacks and early death.
- Type 2 diabetes linked to markedly higher risk of hearing loss, major review finds
- Growing evidence that GLP-1 drugs make type 2 diabetes remission possible
- GLP-1 receptor agonists can reduce mortality in people with type 2 diabetes
It is a bold claim, but it is grounded in long term outcome data from two large cohorts.
As always, there is a reality check.
This is a post hoc reanalysis rather than a new intervention trial designed specifically to test remission as the target.
It strengthens the case for aiming higher than delay, but it does not settle the question of the best way to achieve remission in real world care, or which approaches deliver remission safely across different groups.
Reference: Prediabetes Remission and Cardiovascular Morbidity and Mortality: post hoc analyses from DPPOS and DaQingDPOS. The Lancet Diabetes and Endocrinology. 2025. DOI: 10.1016/S2213-8587(25)00295-5
