Delaying Type 2 Diabetes Can Reduce Your Risk of Heart Disease and Death

• People who delayed the onset of type 2 diabetes for 4 years or more had a lower long-term risk of death and diabetes complications.
• Participants in the study were all diagnosed with prediabetes and elevated blood sugar not high enough to be considered type 2 diabetes.
• Lifestyle programs of healthy diet and physical activity have been shown to reduce the risk of developing type 2 diabetes.

People with prediabetes who were able to delay the onset of type 2 diabetes for 4 years or more through healthy diet and exercise had a lower long-term risk of death and diabetes complications, a new study shows.

Prediabetes means your blood sugar level is higher than normal but not high enough to be considered type 2 diabetes. It is sometimes known as impaired glucose tolerance or borderline diabetes.

“This study underscores the importance of efforts to improve health and reduce the risk for diabetes because that will make a big difference later on,” said Peter Senior, PhD, director of the Alberta Diabetes Institute at the University of Alberta.

“There’s a big difference between getting diabetes at the age of 85 and getting it at 45,” he told Healthline. “If you get it at 45, you could be looking at a lot of years of life lost.”

Senior was not involved in the new study, which was published July 9 in PLoS Medicine. 

Delaying diabetes gives long-term health benefits

In the new study, researchers examined health outcomes for 540 people with prediabetes who participated in an earlier study conducted in China known as the Da Qing Diabetes Prevention Study.

In this study, people were randomly assigned to a control group or to one of three intervention groups. The intervention groups involved a 6-year program of healthy eating, regular exercise, or both. Researchers followed participants for an average of 30 years after the interventions.

In the new analysis, researchers found that people who delayed their diabetes diagnosis for at least four years after their initial prediabetes diagnosis had a lower risk of dying from any cause or from having a cardiovascular event such as coronary heart disease, stroke, or heart failure.

They also had a lower risk of diabetes-related eye, kidney, or nerve problems when compared to people who developed diabetes at an earlier age.

In addition, people who delayed their diabetes diagnosis for at least 6 years had a lower risk of dying due to cardiovascular disease compared to those who were diagnosed with diabetes earlier.

There was no protective effect for people who delayed their diabetes diagnosis for fewer than 4 years.

“This suggests that a longer diabetes-free time may lower the risk of long-term adverse outcomes,” the authors wrote in the paper. “Taking action, including but not limited to lifestyle intervention, to prolong the diabetes-free time in people with prediabetes may be crucial.”

Healthy eating and physical activity lowered diabetes risk

Senior pointed out that the original Da Qing study and the U.S. National Diabetes Prevention program both showed that it is possible to prevent people from developing diabetes.

The National Diabetes Prevention Program is a lifestyle change program that focuses on healthy eating and physical activity. Research showed that people with prediabetes who joined this program reduced their risk of developing type 2 diabetes by 58%.

“We’ve also learned over the years that if you have diabetes and you’re able to keep your blood sugars in target, that that’s going to be beneficial over the long run,” said Senior.

So, “if you have someone who has diabetes and you work with them intensively, even if it’s just for 5 or 10 years, that will set them up for better long-term health decades later, compared to those who are left to fend for themselves.”

However, if you delay getting your blood sugar under control, you may not see the same kind of long-term health benefits as someone who started earlier.

Senior compares it to saving for retirement, where it’s best to start setting aside money when you are 20 rather than waiting until you’re 50. Only in this case, you are accumulating health benefits.

The new study, he said, extends this thinking to earlier, before people get diabetes.

“If we intervene with lifestyle changes, that means a person’s diabetes is delayed,” he said. “And even if you do develop diabetes later, you’re still going to be at an advantage over people whose diabetes came on much sooner.”

Type 2 diabetes is a complex disease

The new study included people who had prediabetes, so they had a higher risk of developing type 2 diabetes.

One public health approach would be to identify people like this who are at higher risk of diabetes and focus intensive interventions on them. This is the approach used by the National Diabetes Prevention Program.

“But if the intervention is healthy eating and healthy lifestyle, there’s no harm in those,” said Senior. “So let’s recommend them for everybody, maybe with extra coaching for those who are at highest risk [of diabetes].”

Although healthy eating and regular exercise can lower the risk of developing type 2 diabetes, Senior cautioned against seeing diabetes solely as a “lifestyle disease.”

“Behaviors, lifestyle, and the situations people find themselves in will all impact the age at which they get diabetes,” he said. 

But genetics also play an important role in the development of diabetes.

“There are people who are destined to get diabetes no matter what,” he said. “In their case, it may be more about delaying diabetes until later in life, and that’s still very worthwhile.”

Still, “there’s a real risk that we could reinforce stigma about diabetes,” he said. “If somebody gets diabetes, they could be criticized for eating the wrong foods or not doing enough of the right thing.”

But “that misunderstands the nature of diabetes,” he said. “There will be people who get diabetes who have been really careful with their lifestyle but got diabetes because of their genetics.”

Takeaway

Researchers looked at health outcomes for people with prediabetes who participated in an earlier study comparing lifestyle interventions — healthy eating, exercise, or both — to no intervention.

People who delayed the onset of diabetes by 4 years or more had a lower risk of dying from any cause or from having a cardiovascular event such as coronary heart disease, stroke, or heart failure. They also had a lower risk of diabetes-related eye, kidney, or nerve problems.

Other research has shown that lifestyle programs such as healthy eating and physical activity can reduce a person’s risk of developing type 2 diabetes. However, genetics also play a role in whether someone develops diabetes.