According to the Centers for Disease Control and Prevention, more than 2 in 5 adults in the United States have prediabetes, a condition where blood glucose levels are higher than they should be, but not as high as in type 2 diabetes.
Risk factors for developing prediabetes include having overweight or obesity, being at least 45 years old, having a close relative with type 2 diabetes, having ever had gestational (pregnancy) diabetes, or given birth to a baby weighing more than 9lbs (4kg).
People with prediabetes are at risk of developing a number of chronic health conditions, as well as progressing to type 2 diabetes, and often end up with multimorbidity — having 2 or more chronic conditions.
A number of lifestyle changes, including losing weight, being more physically active, and adopting a healthier diet, can help prevent this. If these changes do not lower blood glucose, clinicians may prescribe the type 2 diabetes drug metformin.
However, a study published in JAMA has shown that lifestyle modifications may be more effective than metformin for preventing multimorbidity in people with prediabetes.
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“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.”
– Thomas M. Holland, Physician Scientist and Assistant Professor, Department of Internal Medicine, RUSH Institute for Healthy Aging, Chicago, who was not involved in the study.
“Everyone wants to live a longer, healthier life,” David Cutler, MD, board certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, who was also not involved in the study, told MNT. “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 advised that the 15 common conditions included in multimorbidity are:
Multimorbidity has been estimated to affect up to 95% of the primary care population aged 65 years and older, and the risk is increased in people with prediabetes.
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“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.”
— Thomas M. Holland, assistant professor
The researchers carried out a 21-year observational study using data from participants in the Diabetes Prevention Program (DPP) and DPP Outcomes studies (DPPOS). The 1,173 people analyzed were randomly allocated to a lifestyle intervention, metformin, or placebo.
The lifestyle intervention group undertook 16 individual sessions, then monthly sessions for approximately 2 years, which aimed to reduce their calorie and fat intake (<25% kcal from fat), and incorporate at least 150 minutes of physical activity a week to achieve at least 7% weight loss from baseline. They were then offered booster sessions twice a year.
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The metformin group took 850mg metformin twice daily, and the placebo group took an identical dummy tablet twice daily. Both these groups were also offered lifestyle advice sessions 4 times a year.
At the beginning of the 21 years, the participants had a median age of 51 years, and a median BMI of 32.1 (having obesity). The majority, 56%, were non-Hispanic white, with almost a quarter non-Hispanic Black, and the rest Hispanic, Asian/Pacific Islander, and Native American.
At the end of follow-up, 85% of participants had multimorbidity, with the most common conditions beinghyperlipidemia (high cholesterol, 76%),hypertension (high blood pressure, 75%), anddiabetes (67%).
However, the number of chronic conditions differed between groups. In the placebo and metformin groups, participants had a median of 5 chronic conditions, whereas in the lifestyle group, the median was 4.
In total, 82% of the lifestyle group, 85% of the metformin group, and 87% of the placebo group had 2 or more chronic conditions.
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However, while81% of both the placebo and metformin groups had more than 3 chronic conditions, just 72% of the lifestyle group did.
“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,” Holland told Medical News Today.
“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.”
— Thomas M. Holland
Holland advised further:
“From a mechanistic perspective, healthy lifestyle behaviors can reduce chronic inflammation, improve insulin sensitivity, support vascular health, optimize blood pressure, preserve muscle mass, and promote healthy brain aging,” he told MNT.
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He added that, like many chronic conditions, including diabetes, cardiovascular disease, dementia, kidney disease, and certain cancers, share a number of common pathways, improving lifestyle can produce benefits that extend well beyond any single diagnosis.
“For most people,” he told MNT, “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.”
“For some people, that may mean taking longer daily walks or incorporating resistance training into their routine. For others, it may involve improving dietary quality by eating more fruits, vegetables, legumes, whole grains, healthy fats, and lean proteins while reducing highly processed foods. Others may benefit from focusing on sleep, stress management, or strengthening social connections,” said Holland.
“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.”
— David Cutler
