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 .
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 pr eventing multimorbidity in people with prediabetes.
“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.”
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.
“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.”
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 (
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 being hyperlipidemia (high cholesterol, 76%), hypertension (high blood pressure, 75%), and diabetes (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.
However, while 81% of both the placebo and metformin groups had more than 3 chronic conditions, just 72% of the lifestyle group did.