Reversing Prediabetes Alone Isn’t Enough to Live Longer

People who have prediabetes can often take steps to normalize blood sugar levels and prevent the condition from progressing to type 2 diabetes. But new research suggests getting blood sugar levels under control may not be enough to keep you healthy long-term.

According to a recent study published in JAMA Network Open, adults diagnosed with prediabetes who got back to having normal blood sugar levels did not have a lower risk of dying compared to people who have prediabetes.

However, when paired with two major lifestyle behaviors—getting more physical activity and not smoking—reversing prediabetes was linked to a lower risk of death and a longer life expectancy. 

Wenyuan Li, ScD, of Zhejiang University in China, a co-first author of the study, told Verywell that the study’s findings highlight “the significance of lifestyle modifications for those who are in prediabetes status, offering healthcare providers new evidence on identifying populations that may benefit more from certain lifestyle modifications.”

Here’s what experts say about reversing a prediabetes diagnosis, including what steps you need to take to improve your overall long-term health and increase your life expectancy.

Reversing Prediabetes

Li and colleagues conducted a prospective cohort study with data from 45,782 participants from the Taiwan MJ Cohort Study. More than half of the participants (62.9{2c3a8711102f73ee058d83c6a8025dc7f37722aad075054eaafcf582b93871a0}) were men and the average age was 44.6 years. All of the participants were diagnosed with prediabetes during an initial clinic visit between 1996 and 2007.

According to Li, the adults who went from prediabetes to normal blood sugar levels and took up health-supporting habits like getting regular physical activity had a notably lower mortality risk.

Adults who reversed prediabetes and stayed physically active had a 2.5-year longer life expectancy than people with prediabetes who were not physically active.

Participants who got their blood sugar levels back to normal but were current smokers had a 3.6-year lower life expectancy than people with persistent prediabetes who had never smoked. 

The researchers determined each participant’s diabetes status using diagnostic criteria by the American Diabetes Association (ADA).

Specifically, the researchers defined:

• Prediabetes: Fasting plasma glucose (FPG) level of 100 mg/dL to 125 mg/dL
• Normal blood sugar levels (normoglycemia): FPG level of less than 100 mg/dL
• Diabetes: FPG level of 126 mg/dL or higher, a healthcare provider’s diagnosis of diabetes, or the use of diabetes medications

There are several limitations to the study, Eliud Sifonte, MD, an endocrinologist with NYU Langone who was not involved in the research, told Verywell, including that the definition of prediabetes was based on a one-time measurement of blood sugar levels.

In addition, the study was done in Taiwan and may not be generalizable to other populations with different demographics and lifestyle characteristics.

Given these limitations, the results should be interpreted with caution.

Why Wouldn’t Lowering Blood Sugar Levels Be Enough?

While it’s not entirely clear why adults who reverse prediabetes do not have a lower risk of dying than people with persistent prediabetes, Li said it might be because there are individual underlying health disorders and conditions that affect risk.

“After reversion to normoglycemia, individuals may still have underlying metabolic abnormalities that increase their risk of death,” said Li.

Other experts who were not involved in the study theorized that if people have diabetic conditions and are insulin resistant, they are generally at a higher risk of developing other health conditions like heart disease.

People with diabetes are also more likely to have risk factors such as high blood pressure and high cholesterol which can increase their chances of having a heart attack or stroke—conditions that can be fatal.

“Even if the blood sugar is well controlled, if we’re not addressing other things like blood pressure, hypercoagulability state or other inflammatory markers, we might not see improved mortality,” Pouya Shafipour, MD, a board-certified family and obesity medicine physician of Providence Saint John’s Health Center in Santa Monica, CA, told Verywell.

Why Does Exercise Help?

Steven Malin, PhD, FACSM, an associate professor of metabolism and endocrinology in the Department of Kinesiology and Health at Rutgers University, told Verywell that exercise can have this effect on life expectancy because it promotes muscle contraction, which stimulates glucose uptake even if a person is insulin resistant.

“After we eat meals, the body makes insulin but tissues like muscle do not respond well to insulin when it is insulin resistant,” Malin, who was not involved in the study, said. “Exercise, however, can override that and take up glucose still. It is a powerful therapy and the effects last for a few hours after the bout of movement.”

Malin said that exercise also helps our muscles become more insulin sensitive for up to 48 hours, which means the body does not need as much insulin after meals to get the same effect in terms of lowering blood sugar levels.

According to Li, when people are physically active, it also helps reduce inflammation and oxidative stress in the body—both of which are associated with a higher risk of chronic disease and greater mortality.

What About Smoking?

Malin said smoking stimulates stress hormones in the body and damages blood vessels that are crucial for the delivery of insulin to tissues (like muscle).

“Removing smoking can minimize stress hormones that induce insulin resistance as well as improve blood vessel function, thereby enabling more oxygen/nutrients and hormones to reach muscle for better bodily function,” he said.

Other Habits to Improve Blood Sugar Levels

Overall, Li said that adopting healthy lifestyle behaviors like getting regular physical activity and quitting smoking can help improve overall health and reduce the risk of mortality for people with prediabetes.

Besides quitting smoking and exercising more, experts say there are other lifestyle changes you can make to help lower and manage your blood sugar, improve your health, and live longer:

• Get enough sleep. Adults need about 7 to 9 hours of sleep a night. Sifonte said that poor sleep habits can increase your appetite and may promote weight gain which can affect blood sugar levels. Not getting enough sleep can also raise levels of cortisol, one of the hormones that regulate blood sugar.
• Eat a nutritious diet. Consuming foods that are rich in vitamins, minerals, antioxidants, and fiber such as fruits, vegetables, whole grains, fish, and nuts can help prevent many chronic diseases, including diabetes. According to Sifonte, making changes to your diet can help control blood glucose levels and, in some cases, reverse the disease when started early. You can try different eating patterns until you find one that meets your needs, but you may want to start with the Mediterranean diet or the DASH diet.
• Manage stress levels. Malin said that keeping stress in check can give you the energy you need to exercise, improve your sleep, minimize food cravings, recover from your daily tasks, and avoid unhelpful coping behaviors like smoking or drinking alcohol. Reducing your stress can also help you manage your glucose levels better.