Delaying diabetes for 4 years via lifestyle changes lowers heart disease, death risk

• Researchers based in China conducted a post-hoc study of people with a prediabetes diagnosis.
• People often receive a diagnosis of prediabetes before developing type 2 diabetes, and sometimes people can avoid type 2 diabetes with interventions.
• The researchers reviewed more than 30 years of data for people following their prediabetes diagnosis.
• The scientists learned that people who avoided developing type 2 diabetes for at least 4 years had reduced rates of developing cardiovascular disease and lower all-cause mortality rates.

Type 2 diabetes is a common condition that increases healthcare costs by billions of dollars per year. Developing type 2 diabetes can also contribute to a host of complications, such as vision problems, increased risk of heart attack and stroke, and nerve damage.

Researchers study type 2 diabetes to learn more about how to reduce the problems it causes. A study led by Guangwei Li at the China-Japan Friendship Hospital took a look at the effects of postponing the development of type 2 diabetes in people who already had a diagnosis of prediabetes .

The study found that putting off developing type 2 diabetes for at least 4 years can lead to many improvements in the long term, including reducing the risk of death and diabetes-related health complications, such as cardiovascular disease .

The study findings appear in PLOS Medicine .

How prediabetes can lead to type 2 diabetes

According to the American Diabetes Association , around 36 million people in the United States have type 2 diabetes. Additionally, nearly 100 million people in the U.S. have prediabetes.

Prediabetes, also known as insulin resistance, occurs when someone’s blood sugar level is higher than the healthy range. People with A1C levels of 5.7 to 6.4% qualify for prediabetes, and people with an A1C level higher than 6.4% qualify for type 2 diabetes.

With interventions such as making healthy lifestyle changes or taking metformin , people can improve their A1C levels and reverse a prediabetes diagnosis.

When people are unable to do this and end up developing type 2 diabetes, they are at risk for many health issues , including:

• diabetic retinopathy
• artery disease
• congestive heart failure
• hyperglycemia (high blood sugar)
• increased risk of infections.

With this in mind, researchers in the current study wanted to look at the long-term benefits of delaying a type 2 diabetes diagnosis.

Lower risk of death, cardiovascular disease

The study analyzed data from the Da Qing Diabetes Prevention Study (DQDPS) and examined the health outcomes of 540 participants with prediabetes who were followed for more than 30 years.

During this period, the DQDPS tracked death, cardiovascular events, and microvascular complications.

The scientists next checked the participant data at 2, 4, and 6 years post-diagnosis to see whether the participants had reversed their prediabetes diagnosis or developed type 2 diabetes.

They next compared this to all-cause mortality, cardiovascular events, and microvascular complications data from 30 years to determine how helpful delaying type 2 diabetes can be.

The findings showed that postponing developing type 2 diabetes can be beneficial in the long run.

At the 2-year point of the study, of the 539 participants who were still alive, 70 had diabetes, and 469 did not. At the 4-year mark, 176 of the 533 remaining participants developed diabetes, and 357 did not.

At the 6-year point, 254 out of the remaining 520 participants developed diabetes, and 266 participants were diabetes-free.

People who kept diabetes at bay for at least 4 years after receiving a prediabetes diagnosis had a lower risk of death, microvascular complications, and cardiovascular disease.

Over the 30-year follow-up, the researchers learned that participants who progressed to diabetes before the 4-year point had consistently higher glucose (sugar) levels, body mass index (BMI), blood pressure, and were more likely to smoke than those who remained free of diabetes.

Those who remained diabetes-free for at least 4 years had a 26% lower risk of all-cause mortality and a 40% lower risk of vascular problems.

Participants who remained free of diabetes for at least 6 years following their prediabetes diagnosis saw even more benefits — they had a 44% reduction in cardiovascular death.

These findings suggest if people with prediabetes can delay developing type 2 diabetes for at least a few years, they can reduce their chances of health issues in the long run.

Why does diabetes prevention lower other health risks?

Daniel Atkinson, MBBS , clinical lead at Treated.com, and a general practitioner based in the United Kingdom, weighed in on the study for Medical News Today . Atkinson was not involved in the original study.

“It’s an impressive and thorough piece of research involving 540 people, and the extensive period of analysis (30 years) gives added weight to the findings,” commented Atkinson.

“I would say it also paints a reassuring picture for people who may be at increased risk of diabetes, due to their ethnicity, family history, or other factors outside of their control; by suggesting that there are practical things you can do to lower your risk of diabetes complications if you develop the condition,” he continued.

Atkinson said the study does a good job of reinforcing current recommendations.

“I think it’s important to say that there’s lots people can do to prevent diabetes and ‘prediabetes’ and this study reinforces that,” he said.

However, he added:

“It doesn’t mean that getting type 2 diabetes means giving up hope. Many recently diagnosed people can make changes which mean that they’re no longer diabetic if they can make these changes and maintain them for the long term.”

Absalon Gutierrez, MD , an associate professor and endocrinologist with UTHealth Houston, also spoke with MNT about the study findings. Dr. Gutierrez also did not participate in this research.

“It is a ‘post-hoc analysis,’ which means it is subject to several statistical biases, hence dampening some enthusiasm for the pleasing results,” Gutierrez explained. “However, the findings are consistent with our current belief that delaying a diagnosis of diabetes yields multiple future health benefits.”

Gutierrez touched on the mechanisms that might provide the protective effect delaying diabetes for 4 years can have.

“Some of this is likely due to less destruction of pancreatic beta cells as well lower levels of insulin resistance in muscle and fat,” he explained.

Gutierrez also noted that despite the developments in weight loss and diabetes medications since the study began, obesity levels are still going up.

“It is important for people at risk with diabetes to take diabetes prevention seriously,” he emphasized.