{"id":945,"date":"2026-06-18T16:43:16","date_gmt":"2026-06-18T13:43:16","guid":{"rendered":"https:\/\/www.life-on.com.ua\/?p=945"},"modified":"2026-06-18T16:43:18","modified_gmt":"2026-06-18T13:43:18","slug":"prediabetes-remission-cardiovascular-risk","status":"publish","type":"post","link":"https:\/\/www.life-on.com.ua\/en\/prediabetes-remission-cardiovascular-risk\/","title":{"rendered":"Prediabetes remission and the heart: why \u00ab\u221258%\u00bb is not about diet, but about results."},"content":{"rendered":"

Prediabetes remission \u2014 a return to normal blood sugar levels \u2014 has been making headlines alongside the figure \u00ab\u221258%\u00bb: apparently, this is how much the risk of cardiovascular death falls. It sounds like a reward for a healthy lifestyle. But if you look at the original source, the story is more nuanced and interesting. Yes, remission from prediabetes is indeed linked to a sharp reduction in cardiac events. However, those very same studies had previously revealed a paradox: lifestyle changes alone did not save hearts. It is not the attempt that counts, but the result achieved. Let\u2019s break down what is science and what is press release hyperbole.<\/p>\n\n\n\n

What is prediabetes remission<\/h2>\n\n\n\n

Prediabetes is when blood sugar is already elevated, but not yet meeting the criteria for type 2 diabetes. The condition is extremely common, with over a billion people worldwide estimated to be affected. In the US, it's more than one in three adults, and in China, it's four out of ten.<\/p>\n\n\n\n

Prediabetes remission simply means: glucose levels have returned to the normal range according to the American Diabetes Association's criteria.<\/p>\n\n\n\n

In figures, it looks like this: fasting glucose is below 5.6 mmol\/l, and HbA1c (a measure of average blood sugar over three months) is below 5.7%. Prediabetes is the zone between normal and diabetes: fasting glucose of approximately 5.6\u20136.9 mmol\/l or HbA1c of 5.7\u20136.4%. Bringing these values back into the normal range and maintaining them constitutes prediabetes remission.<\/p>\n\n\n\n

For many years, prediabetes lacked a clear treatment target. A new study proposes a measurable target. And it examines what prediabetes remission does for the heart.<\/p>\n\n\n\n

What the study actually showed<\/h2>\n\n\n\n

This is not a new prospective study but a post-hoc analysis of two old diabetes prevention programmes. The American DPPOS \u2013 2402 participants, median follow-up of 20 years. The Chinese DaQing \u2013 540 participants, over 30 years. Both once tested intensive lifestyle changes.<\/p>\n\n\n\n

In the DPPOS trial, only 11.5% people \u2014 275 out of 2,402 \u2014 achieved remission from prediabetes after one year. This is a sobering realisation. Even under medical supervision, only a minority manage to bring their blood sugar levels back to normal.<\/p>\n\n\n\n

Now for the main figures. In the remission group, the rate of cardiovascular death or hospitalisation for heart failure was 1.74 versus 4.17 per 1000 person-years. The fully adjusted hazard ratio was 0.41. In the Chinese cohort, the result was confirmed: HR 0.49.<\/p>\n\n\n\n

It's worth explaining the background here, as diabetes prevention and heart attack prevention are not the same thing. The DPP (Diabetes Prevention Program) became famous at the time for showing that lifestyle changes reduced the incidence of diabetes by about a quarter. A powerful result for prevention. However, you can delay the moment when pre-diabetes becomes diabetes for years and still not shift cardiovascular risk.<\/p>\n\n\n\n

And this is where prediabetes remission becomes a separate, more ambitious goal \u2013 not to \u00abpostpone diabetes\u00bb, but to return glucose to normal. It is this difference that explains the data. The same programmes prevented diabetes, but did not protect the hearts of those who did not achieve prediabetes remission.<\/p>\n\n\n\n

Where did \u00ab\u221258%\u00bb come from, and why is it rounded?<\/h2>\n\n\n\n

The press release reported the effect as \u00ab\u221258%\u00bb. In the article itself, the key coefficients are different: 0.41 in the US cohort and 0.49 in the Chinese cohort. In the pooled analysis, the figures are 0.47 for the cardiovascular composite endpoint and 0.63 for all-cause mortality.<\/p>\n\n\n\n

A risk ratio of 0.47 means \u00abroughly half as much\u00bb, not exactly \u221258%. The figure 58% is a separate calculation by King\u2019s College London based on a slightly different data set. It is not incorrect. However, in the headline, it is presented without confidence intervals and without the context provided in the article.<\/p>\n\n\n\n

Confidence intervals are important here. For prediabetes remission in an American cohort, the coefficient interval is from 0.20 to 0.84. This means the effect is almost certainly present, but the exact size is blurred: from \u00abthree times less\u00bb to \u00aba little less\u00bb. A nice round number hides this uncertainty.<\/p>\n\n\n\n

The paradox of prediabetes remission that the digest missed<\/h2>\n\n\n\n

Here's the most interesting part, and what makes the topic worthy of a post. The very same studies previously showed something rather unpleasant. Intensive lifestyle changes \u2013 exercise, weight loss, better diet \u2013 did not significantly reduce cardiovascular risk in people with prediabetes.<\/p>\n\n\n\n

The reduction is not the attempt, but the achieved result. A similar \u00abthe outcome matters, not the intention\u00bb effect was seen in Analysis of diurnal rhythm and movement against mortality<\/a>. The activity itself isn't important, but whether the sugar has truly fallen to normal levels and stayed there.<\/p>\n\n\n\n

This is counterintuitive. We're used to thinking: do the right things \u2013 get protection. The data says something subtler. Protection is linked to the metabolic outcome, not to the fact of making the effort itself. Lifestyle is a tool to achieve remission. But without achieving normal glucose levels, the cardiac bonus isn't guaranteed.<\/p>\n\n\n\n

The logic behind this connection is not made up. Chronically elevated blood sugar damages the inner lining of blood vessels, increases inflammation, and promotes arterial stiffness. This gradually increases blood pressure and the workload on the heart, hence the risk of heart attack and heart failure. When blood glucose returns to normal, some of these processes slow down, so the effect makes physiological sense.<\/p>\n\n\n\n

Why is this still not proof of causation<\/h2>\n\n\n\n

There is an obligatory caveat here, which is the first thing to disappear from the sensational headlines. This is a post-hoc analysis, not a randomised trial where people would be deliberately brought into remission.<\/p>\n\n\n\n

Therefore, prediabetes remission might not be the cause of a healthier heart, but a marker. It's possible that those whose metabolism is more flexible from the outset, who have a healthier liver, and lower inflammation, are the ones returning to normal. Then, it's not the remission itself that protects them, but the favourable conditions that allowed remission to occur.<\/p>\n\n\n\n

Researchers honestly admit this and directly call the result an association. An editorial comment in the same journal adds another point: there isn't even a single definition of prediabetes and remission across countries. This isn't a reason to ignore the finding. It is a reason not to present it as a proven cause.<\/p>\n\n\n\n

What does this mean for the Ukrainian reader<\/h2>\n\n\n\n

Yes, the topic concerns us too. Prediabetes is mostly asymptomatic \u2013 a person may not know their sugar levels are rising for years. Its prevalence is high, and Ukraine is no exception to the general pattern of metabolic problems after the age of 40.<\/p>\n\n\n\n

The practical meaning is simple. If the analysis showed elevated fasting glucose or high HbA1c, it's not a death sentence, but it's also not a minor issue that can be put off. Normal glucose levels are realistically achievable: in studies, people returned to and maintained them for decades. The main levers here are exercise and diet, along with weight control. More details about the impact interval sprints for insulin sensitivity<\/a> We wrote separately.<\/p>\n\n\n\n

What does this mean in terms of actions? Testing fasting glucose and HbA1c at least once a year after 40 is cheap and informative. If the numbers are in the pre-diabetic zone, the goal is not to \u00abworry less\u00bb but to achieve a measurable shift in results in the next test. The benchmark is not the ideal protocol from the headline, but the normal range recorded by the laboratory.<\/p>\n\n\n\n

There is no need to wait for a \u00abmagic protocol\u00bb for this. A minority even in clinical settings achieved remission. The realistic goal is to move in the right direction under medical supervision, rather than chasing an ideal figure from a headline.<\/p>\n\n\n\n

What should be taken from this<\/h2>\n\n\n\n

Firstly: remission of prediabetes is a strong indicator, but the data describe an association rather than a proven cause. An HR of 0.41\u20130.63 represents \u00abroughly half the risk\u00bb, with a wide confidence interval, rather than the precise figure of \u00ab\u221258%\u00bb.<\/p>\n\n\n\n

Secondly: a crucial outcome, not a process. The lifestyle itself in these studies didn't save the heart \u2013 returning glucose to normal did. This is an argument for checking test results, not for believing that \u00abI'm trying, therefore I'm protected.\u00bb.<\/p>\n\n\n\n

Thirdly, the authors cautiously place prediabetes remission alongside the three classic prevention targets \u2013 blood pressure, cholesterol, and smoking cessation. As a possible fourth. And it is precisely this \u00abpossible\u00bb \u2013 and this honest formulation is worth adopting instead of a loud percentage.<\/p>\n\n\n\n

In short: normal sugar levels are a good goal. But they should be measurable, verified by tests, and discussed with a doctor, not just read from a headline.<\/p>\n\n\n\n

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Sources<\/strong><\/p>\n\n\n\n