A new long-term study suggests that structured lifestyle changes such as improved diet, weight loss, and regular physical activity may be more effective than medication alone in reducing the risk of multiple chronic diseases in people with prediabetes.
Prediabetes is a metabolic condition in which blood sugar levels are higher than normal but not yet in the diabetic range. Without intervention, it can progress to type 2 diabetes and is also linked to a higher risk of heart disease, stroke, and other long-term health complications.
Health agencies estimate that more than two in five adults in the United States have prediabetes, making it one of the most common metabolic risk conditions globally.
Prediabetes Linked to Broader Health Risks
Medical experts say prediabetes is not only a warning sign for diabetes but also an indicator of broader metabolic dysfunction. Individuals with the condition are more likely to develop multiple long-term illnesses over time, a situation known as multimorbidity, where a person lives with two or more chronic diseases.
Risk factors include excess body weight, age above 45, a family history of type 2 diabetes, a history of gestational diabetes, and giving birth to larger-than-average babies.
Lifestyle Intervention Compared With Medication
The findings come from a 21-year follow-up study of participants in the Diabetes Prevention Program, which compared three groups: a structured lifestyle intervention group, a metformin treatment group, and a placebo group.
The lifestyle programme focused on calorie reduction, healthier dietary patterns, increased physical activity of at least 150 minutes per week, and achieving weight loss targets. Participants also received ongoing behavioural support over several years.
The medication group received metformin, a commonly prescribed drug used to improve insulin sensitivity, while the placebo group received inactive treatment. Both medication groups also received periodic lifestyle guidance.
Fewer Chronic Conditions in Lifestyle Group
At the end of the follow-up period, researchers found that most participants developed more than one chronic condition regardless of intervention type. However, those in the lifestyle intervention group developed fewer overall health conditions compared with those taking metformin or placebo.
The most commonly reported conditions included high cholesterol, high blood pressure, and type 2 diabetes.
Although multimorbidity remained high across all groups, participants who followed structured lifestyle changes showed a lower burden of disease over time.
Why Lifestyle Changes Make a Difference
Health experts explain that lifestyle interventions affect multiple biological systems at the same time, including inflammation, blood sugar regulation, cardiovascular function, and weight control.
In contrast, medications such as metformin primarily target specific pathways related to glucose regulation.
Researchers say this broader impact may explain why diet and exercise interventions appear to offer wider long-term protection against multiple chronic conditions.
Chronic Disease Prevention Beyond Diabetes
Medical specialists note that conditions such as diabetes, heart disease, kidney disease, dementia, and certain cancers often share common underlying risk factors.
As a result, improvements in diet, physical activity, sleep quality, and stress management may help reduce the risk of several diseases simultaneously, not just diabetes.
Experts emphasise that even moderate lifestyle changes, such as regular walking, healthier food choices, and weight management, can have measurable health benefits over time.
Implications for Public Health
Health professionals say the findings reinforce the importance of early prevention strategies in people with prediabetes, particularly given the rising global burden of metabolic disease.
They add that while medications remain important in many cases, lifestyle modification should remain the foundation of long-term chronic disease prevention.
Researchers also highlight that sustained behavioural changes may be one of the most effective tools for reducing multimorbidity and improving quality of life as people age.
