Prediabetes is a warning sign that your metabolism is faltering. But most people think of prediabetes as the step before type 2 diabetes, rather than a condition that can be reversed
Most advice for prediabetes focuses on preventing type 2 diabetes through weight loss and exercise, with far less attention on whether blood sugar can actually return to normal.
In episode 87 of the podcast, Dr Jedha spoke about ‘prediabetes remission,’ a relatively new term in the research field.
A new major long-term study published in The Lancet Diabetes & Endocrinology makes a new finding to confirm that prediabetes remission is your number one goal.
Researchers followed people with prediabetes for up to 30 years and found that those who restored normal blood sugar levels had significantly better cardiovascular outcomes, including much lower rates of heart failure and cardiovascular death.
What the Study Looked At
Researchers analyzed data from two large diabetes prevention studies, one conducted in the United States and one in China. Together, these studies followed nearly 3,000 adults with prediabetes over several decades.
Participants were grouped based on whether they achieved prediabetes remission. Remission was defined as returning fasting glucose, post-meal glucose, and A1c to normal ranges without glucose-lowering medication.
The researchers then examined long-term cardiovascular outcomes, focusing on heart failure hospitalization and cardiovascular mortality.
What the Study Found
The findings were consistent and clinically meaningful.
People who achieved prediabetes remission had about a 50% lower risk of cardiovascular death or hospitalization for heart failure compared with those who didn’t reach remission.
These benefits weren’t short term. They persisted for decades, even after lifestyle interventions ended, indicating a strong legacy effect of restoring normal glucose regulation earlier in life.
The study also found that remission didn’t have to be permanent to matter. Individuals who returned to normal blood sugar levels at least once during follow-up still experienced significant reductions in cardiovascular risk.
Importantly, these associations remained even after adjusting for weight loss, medication use, and whether participants later developed type 2 diabetes.
Why Blood Sugar Normalization Matters
This study reinforces an important message discussed in our podcast on prediabetes remission. Prediabetes isn’t a fixed condition, and it doesn’t inevitably progress to type 2 diabetes.
Even in the prediabetes stage, elevated blood sugar and insulin resistance increase cardiovascular risk. Prolonged exposure to higher-than-normal glucose levels damages blood vessels, promotes inflammation, and places added strain on the heart.
By restoring normal blood sugar levels, the body experiences less metabolic stress over time. This reduced exposure appears to translate into lower rates of heart failure and cardiovascular death later in life.
The findings also help explain why weight loss alone isn’t always enough. While weight loss can improve health, the study showed that achieving normal glucose regulation was a stronger predictor of long-term cardiovascular protection than weight change alone.
How This Changes the Conversation About Prediabetes
Current prediabetes guidelines focus largely on diabetes prevention rather than remission. The goal is often to slow progression, not to restore normal glucose regulation.
That’s not we focus on here at DMP. We’ve always encouraged our members to restore normal glucose regulation.
This research confirms what we’ve been doing for the past 10 years – that prediabetes remission is a more meaningful and measurable target. Restoring normal glucose regulation should be your number one goal.
To us, that’s just a logical goal. Normal blood sugar reflects improved insulin sensitivity, reduced visceral fat, and healthier overall metabolic function.
When glucose regulation improves, long-term heart health improves with it.
Study Limitations to Keep in Mind
This was a post-hoc observational analysis, meaning participants weren’t assigned to remission or non-remission groups from the start. Lifestyle approaches and adherence across the interventions varied over time.
Even so, the consistency of results across two large and diverse populations strengthens confidence in the overall conclusions. Plus, we’re seeing more and more evidence in the area of prediabetes remission, so this study adds value to the discussion.
Practical Takeaways
- Prediabetes remission is achievable
- Restoring normal blood sugar is linked to lower heart disease and heart failure risk
- Even temporary periods of normal glucose regulation appear to provide lasting protection
- Blood sugar improvement offers benefits beyond weight-focused approaches
- Earlier improvement in glucose control is associated with better long-term outcomes
If you’re ready for a clear direction, the DMP Membership is built to show you exactly what to focus on, and what to stop worrying about. And, it’s proven to get results!
Member Jeanette said: “After 4 months I lowered A1c to normal from 5.7 to 5.4, lost 27 pounds (12kg) and my cholesterol is normal for the first time in 15 years. Thank you DMP.”
Study Reference: Vazquez Arreola E, Gong Q, Hanson RL, et al. Prediabetes remission and cardiovascular morbidity and mortality. Lancet Diabetes & Endocrinology. 2025.
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