Lowering blood glucose for people with prediabetes could halve heart attack risk

Addressing blood glucose levels could be “lifesaving”.

Maintaining a lower blood glucose level while living with prediabetes could drastically reduce the risk of additional health complications around heart health.

Researchers at King’s College London have revealed findings that the risk of a heart attack could be more than halved in people with prediabetes, if they bring their blood glucose levels down to normal.

The action could also effectively reverse the condition of prediabetes.

The findings could be especially important for people living with prediabetes following recent research that showed lifestyle changes alone – including exercise, weight loss and dietary improvements – would not lower their cardiovascular risk.

The research, recently published in The Lancet Diabetes & Endocrinology present a new, potentially “lifesaving” target for prediabetes and the prevention of cardiovascular disease, while potentially offering healthcare professionals a significant change in reviewing how these conditions are treated.

The findings revealed that lower blood glucose could cut the risk of death from heart disease or hospital admission for heart failure by more than 50% in people with prediabetes.  

Study lead author Dr Andreas Birkenfeld, Reader in Diabetes, King’s College London and University Hospital Tuebingen, said: “This study challenges one of the biggest assumptions in modern preventative medicine. For years, people with prediabetes have been told that losing weight, exercising more and eating healthier will protect them from heart attacks and early death. While these lifestyle changes are unquestionably valuable, the evidence does not support that they reduce heart attacks or mortality in people with prediabetes. Instead, we show that remission of prediabetes is associated with a clear reduction in fatal cardiac events, heart failure, and all-cause mortality.”  

Prediabetes is a condition where blood glucose levels are higher than normal but not yet high enough to be diagnosed with type 2 diabetes.

Prediabetes frequently progresses to type 2 diabetes and carries risk of cardiovascular disease – one of the leading causes of death globally.

Latest figures in the UK suggest around one in five adults has diabetes or prediabetes.

In the US, that figure is more than one in three, and in China it rises to four in ten. Globally, more than one billion people are estimated to have prediabetes.

Led by Dr Andreas Birkenfeld, the study reanalysed data from two landmark diabetes prevention trials – the US Diabetes Prevention Program Outcomes Study (DPPOS) and the Chinese DaQing Diabetes Prevention Outcomes Study (DaQingDPOS). Both long-term studies followed participants with prediabetes over several decades, with interventions including increasing exercise and eating a healthy diet.

People who had achieved remission from prediabetes had a 58% lower risk of cardiovascular death or hospitalisation from heart failure. This effect persisted decades after normalising glucose levels, suggesting a lasting impact from regulating blood glucose.

The researchers also found that risk of heart attack, stroke and other major adverse cardiovascular events were reduced by 42% in those who had achieved prediabetes remission.

Both the Chinese and US studies offered similar results.

Previous review of these studies had shown combined lifestyle interventions, including increased exercise and eating a healthy diet, did not reduce cardiovascular disease.

Researchers believed this suggested that delaying diabetes onset alone does not guarantee cardiovascular protection unless there were important metabolic changes. 

Dr Birkenfeld added: “The study findings mean that prediabetes remission could establish itself – alongside lowering blood pressure, cutting cholesterol and stopping smoking – as a fourth major primary prevention tool that truly prevents heart attacks and deaths.”

The research is part of a longstanding collaboration between King’s College London and Technische Universität Dresden in Germany, known as the transCampus.

Professor Stefan Bornstein, Dean of transCampus, said: “The transCampus is a unique partnership established by King’s College London and Technische Universität Dresden as a transnational strategic partnership based on the idea of true cooperation and an intense dedication for collaboration in all fields. Guided by shared ideas, values and a devotion to research and education, transCampus enables researchers to work together beyond the means of a traditional partnership by sharing resources, combining their strength, and promoting transnational projects and knowledge transfer.”

Read the full report in The Lancet Diabetes & Endocrinology