Is a diet and exercise program linked to fewer chronic diseases in prediabetes?
Yes, modestly. In a 21-year study of adults with prediabetes, 82% of those in a structured lifestyle program developed two or more chronic diseases, compared with 87% in the placebo group. That is about 5 fewer people out of every 100, or roughly 1 in 20. After adjustment, the lifestyle group’s risk was about 21% lower. Metformin, a common diabetes drug, did not show a clear benefit (85% developed multimorbidity).
This research followed 1,173 adults who started out with prediabetes, meaning their blood sugar was higher than normal but not yet in the diabetes range. They were part of the Diabetes Prevention Program and its long-term follow-up study, one of the most carefully tracked groups in this field. The big question was simple. If you help someone change their habits early, do the benefits reach beyond blood sugar to the rest of their health?
What the data show
The results favored lifestyle. In the original Diabetes Prevention Program, people assigned to the lifestyle program were asked to eat healthier, get at least 150 minutes of physical activity each week, and aim to lose 7% of their body weight. Over the next two decades, 82% of this group developed multimorbidity versus 87% of the placebo group, a risk about 21% lower after adjustment. Multimorbidity is the medical term for having two or more chronic conditions at the same time, such as heart disease, high blood pressure, or arthritis. By the end of follow-up the participants were older (median age 74), and most people in every group had reached that point.
Metformin told a different story. While the drug is well known for helping prevent or delay diabetes, it did not significantly lower the risk of these stacked-up chronic conditions when compared with placebo. The lifestyle link held even when diabetes itself was left out of the count, suggesting that the everyday work of moving more and eating better may help the body in ways a single pill does not.
Dr. Kumar’s Take
Prediabetes is often framed as a narrow blood sugar problem, but this study links the choices people make in those early years to their health decades later. A 5-point absolute drop (21% relative) in the risk of multiple chronic diseases over 21 years is a meaningful number, and it came from changes most people can actually make. This does not mean metformin is useless, because it still has a clear role in preventing diabetes itself. What it does mean is that lifestyle work earns its place as a frontline tool, not a backup plan.
How the study was done
This was an observational follow-up of a randomized trial. Between 1996 and 1999, 3,234 adults at high risk of diabetes were randomly assigned to lifestyle, metformin, or placebo for the 3-year Diabetes Prevention Program. After that trial ended, placebo was stopped, metformin was continued, and from then until 2014 everyone was offered lifestyle classes. Medicare data on chronic conditions were available through 2021 for 1,173 of the original participants who gave consent. Each group was compared with placebo, not with each other, and the later mixing of treatments means the results show an association rather than proof of cause. The very long follow-up is the real strength here. Many studies end after a year or two, but chronic diseases build slowly, so watching people for two decades gives a much truer picture of what these early choices actually do over a lifetime.
Who this matters for most
If you have been told you have prediabetes, this research speaks directly to you. The lifestyle goals used in the study were specific but realistic. The findings suggest the payoff is not only avoiding diabetes but also lowering your odds of carrying several health conditions later in life. That is a future worth working toward, and the earlier you start, the more time the benefits have to add up.
Practical Takeaways
- Aim for at least 150 minutes of activity each week, which breaks down to about 30 minutes on most days, since this was a core goal of the Diabetes Prevention Program lifestyle arm.
- Set a modest weight goal of around 7% of your current weight rather than chasing a dramatic number, because that smaller target was the goal of the Diabetes Prevention Program lifestyle arm, which was linked to lower long-term risk.
- Treat healthier eating as a daily habit, not a short diet, since the benefits in this study came from years of consistency rather than quick fixes.
- Talk with your doctor about whether metformin fits your situation, keeping in mind it helps with diabetes prevention even though it did not lower broader chronic disease risk here.
Related Studies and Research
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FAQs
What is multimorbidity, and why is it a bigger deal than one disease?
Multimorbidity simply means living with two or more long-term health conditions at once, like having both diabetes and heart disease. It matters because these conditions tend to feed off each other, making each one harder to manage and treatment more complicated. Juggling several diseases also means more medications, more appointments, and a heavier daily burden. Lowering the chance of reaching that point is a major win for both quality of life and independence as you age.
Why didn’t metformin lower the risk of multiple chronic diseases?
This study did not pin down the exact reason, so I want to avoid guessing beyond the data. What is known is that metformin mainly targets blood sugar, while a lifestyle program touches many systems at once through weight, fitness, and diet. That broader reach may explain its link to a lower risk across a wider range of conditions. Metformin still has real value for preventing diabetes, but this research suggests its benefits may not stretch as far across the body.
Is it too late to start if I already have prediabetes?
Not at all, and that is the encouraging part of this research. The participants began the program while they had prediabetes, not before it, and they still saw lower long-term risk. This tells me the window for meaningful change is open even after a prediabetes diagnosis. The key is starting soon and staying consistent, since the lower risk in this study was seen over many years.
Bottom Line
In this 21-year study, for adults with prediabetes, a structured program of healthier eating, regular activity, and modest weight loss was linked to a lower risk of developing multiple chronic diseases (82% vs 87% with placebo, about 21% lower after adjustment), while metformin did not show the same broad protection. The authors conclude that lifestyle programs may persistently lower the development of chronic conditions.
