Prediabetes may put your heart, kidneys and brain at risk: Here's how to lower risk

People with prediabetes may be able to do far more than prevent diabetes through simple lifestyle changes. New research suggests that healthy eating, regular exercise, and weight loss could help protect against multiple chronic diseases and may even outperform medication in promoting long-term health.

Published in JAMA, the study found that adults with prediabetes who adopted lifestyle interventions developed fewer chronic conditions over more than two decades of follow-up compared with those who received metformin or placebo.

Researchers noted that while metformin remains an important medication for managing blood sugar, lifestyle modification appeared to provide broader health benefits by reducing the overall burden of chronic diseases.

Prediabetes affects millions, raises risk of multiple illnesses

Prediabetes is characterized by blood sugar levels that are higher than normal but not high enough to be diagnosed as type 2 diabetes. Without intervention, many people with prediabetes eventually progress to diabetes and are also at increased risk of cardiovascular disease, stroke, kidney disease, and other chronic health problems.

Experts say people with prediabetes frequently experience multimorbidity — the coexistence of two or more chronic conditions.

According to the U.S. Centers for Disease Control and Prevention (CDC), more than two in five adults in the United States have prediabetes.

Lifestyle changes outperformed metformin

Over 21 years of follow-up, researchers found that 85% of participants developed multimorbidity. However, people assigned to lifestyle interventions experienced fewer chronic diseases than those receiving metformin or placebo.

Participants in the lifestyle group had a median of four chronic conditions compared with five in both the metformin and placebo groups.

Overall, 82% of those in the lifestyle intervention group developed two or more chronic conditions, compared with 85% in the metformin group and 87% in the placebo group.

Likewise, 72% of participants following lifestyle interventions developed more than three chronic conditions, compared with 81% in both the metformin and placebo groups.

Experts say healthy habits target multiple diseases simultaneously

Thomas M. Holland, Physician Scientist and Assistant Professor in the Department of Internal Medicine at the RUSH Institute for Healthy Aging in Chicago, who was not involved in the study, emphasized the significance of the findings.

"This is a very important finding because it shifts the conversation from preventing a single disease to promoting long-term health across multiple organ systems. The study showed that lifestyle intervention not only reduced progression to diabetes but also lowered the risk of developing multiple chronic conditions over more than two decades of follow-up. That is particularly meaningful given the growing burden of multimorbidity in aging populations."

According to Holland, lifestyle interventions influence several biological pathways simultaneously.

"Lifestyle interventions are likely more effective because they target several different biological pathways simultaneously, rather than focusing on a single aspect of a disease. Metformin is an important and effective medication that primarily improves insulin sensitivity and reduces glucose production by the liver. Lifestyle changes are multifaceted and influence far more than blood sugar."

Chronic disease is not an inevitable part of aging

Holland stressed that aging itself does not necessarily mean developing multiple illnesses.

"One of the most encouraging aspects of this study is the reminder that chronic disease is not simply an inevitable consequence of aging. While aging itself is unavoidable, many of the biological processes that contribute to chronic disease can be influenced by the choices we make throughout life."

He further noted that lifestyle interventions remain central to disease prevention.

"Lifestyle interventions are one of the cornerstones of chronic disease prevention. While medications are often necessary and can be lifesaving, lifestyle factors influence many of the underlying biological mechanisms that drive disease development in the first place."

According to him, healthy habits help reduce inflammation, improve insulin sensitivity, support cardiovascular health, preserve muscle mass, and promote healthy brain aging.

Experts urge people to focus on simple daily habits

David Cutler, MD, a board-certified family medicine physician at Providence Saint John's Health Center in Santa Monica, California, said multimorbidity has become one of the greatest threats to healthy aging.

"Everyone wants to live a longer, healthier life. The biggest enemy preventing this is something now called multimorbidity. The concept here is that it is the many diseases associated with aging that rob us of quality in life as we age."

He highlighted conditions commonly associated with multimorbidity, including hypertension, heart disease, stroke, arthritis, chronic kidney disease, cancer, dementia, depression, osteoporosis, and diabetes.

Cutler stressed that the message remains straightforward.

"The take home message here is clear and not new: diet and exercise work to improve quality of life. Getting this message out has been a struggle for the medical community. Large amounts of money go into marketing drugs, devices, and customized therapies to improve quality of life. There is not enough time or energy devoted to getting out the message that diet and exercise are potent tools for longevity and anti-aging."

Same habits that prevent diabetes may protect heart, brain

Holland noted that the same lifestyle habits that reduce diabetes risk also help maintain overall health.

"For most people, the takeaway is simple — the same habits that help prevent diabetes are often the same habits that help protect your heart, brain, overall health, and quality of life."

He recommended practical changes such as:

• Engaging in at least 150 minutes of physical activity each week.
• Taking longer daily walks and incorporating resistance training.
• Eating more fruits, vegetables, legumes, whole grains, lean proteins, and healthy fats.
• Reducing highly processed foods.
• Prioritizing sleep, stress management, and social connections.

As chronic diseases continue to rise worldwide, experts say the latest findings reinforce a simple but powerful message: lifestyle medicine remains one of the most effective tools for healthy aging and disease prevention.

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