Prediabetes and prevention: Can a lifestyle program lower chronic disease odds?

A long-running U.S. diabetes prevention study has a new finding that matters beyond blood sugar alone. In a June 15, 2026 report in JAMA, adults with prediabetes who had originally been assigned to an intensive lifestyle program had a lower long-term risk of developing multiple chronic conditions than those assigned to placebo.

That does not mean lifestyle changes guarantee protection, and it does not mean every prevention program will produce the same results. But for people with prediabetes, the follow-up adds evidence that structured support around food, physical activity, and weight loss can shape health over many years, not only diabetes risk.

What the study looked at

This paper was a follow-up analysis from the Diabetes Prevention Program and its outcomes study, two well-known U.S. research efforts that began in the 1990s. The original trial enrolled 3,234 adults at high risk for diabetes at 27 U.S. sites. For the new analysis, researchers used Medicare-linked data through 2021 for 1,173 participants who consented to that linkage.

Participants had originally been assigned to one of three groups: an intensive lifestyle intervention, metformin, or placebo. The lifestyle program was not a vague suggestion to “be healthier.” It included coaching, goals for lower calorie and fat intake, at least 150 minutes of physical activity per week, and a target of about 7% weight loss from baseline.

What the results mean in plain language

The key outcome was multimorbidity, meaning two or more chronic conditions. Researchers tracked 15 conditions commonly captured in Medicare data, including diabetes, heart disease, stroke, chronic kidney disease, COPD, depression, dementia, osteoporosis, arthritis, and cancer.

By the end of follow-up, most participants in all three groups had developed at least two chronic conditions. That is important context. This was not a story about avoiding illness altogether. Even so, the lifestyle group did better overall: 82% developed multimorbidity, compared with 87% in the placebo group. After statistical adjustment, the lifestyle group had a significantly lower long-term risk. Metformin did not show a statistically significant reduction compared with placebo in this analysis.

The practical takeaway is that early, sustained lifestyle support may help slow the accumulation of chronic illness in people with prediabetes. That is a broader potential benefit than simply delaying a diabetes diagnosis.

What this study does not prove

This June 2026 paper is not a brand-new trial that kept people on the same blinded treatments for two straight decades. It is a long follow-up of an earlier randomized trial. Over time, the study changed: placebo was discontinued, metformin continued for its original group, and all participants were offered some lifestyle sessions during later follow-up.

That means the findings are meaningful, but they still need careful interpretation. The analysis included only the subset of participants with Medicare data and consent for linkage, and the median age in the final analysis was 74. The results are most directly relevant to adults who had prediabetes and elevated diabetes risk in midlife and were followed into older age. They should not be read as a guarantee that any single class, app, or short-term diet plan will prevent multiple diseases.

It also does not mean metformin has no role in prevention. In current American Diabetes Association guidance, metformin can still be considered for some adults at especially high risk of progressing to type 2 diabetes, including certain people with obesity, higher glucose levels, or a history of gestational diabetes. This study’s metformin finding was narrower: it did not show a statistically significant reduction in long-term multimorbidity compared with placebo.

Who can act on this now

If you have already been told you have prediabetes, this study supports asking for something more specific than general advice to eat better and exercise more. A structured lifestyle program may be worth discussing, especially if you want help with goals, accountability, and follow-up.

If you have not been screened recently but have been told you have borderline glucose, have overweight or obesity, had gestational diabetes in the past, or have other risk factors for type 2 diabetes, this is also a reasonable time to ask whether repeat testing makes sense. The American Diabetes Association says more intensive prevention may be appropriate for people at especially high risk of progressing to diabetes.

And if you already have symptoms that could suggest diabetes, such as increased thirst, frequent urination, blurred vision, or unexplained weight loss, do not wait for a prevention class to get checked. Prevention programs can help, but they are not a substitute for medical evaluation when symptoms are already developing.

Access in the U.S.: programs and Medicare coverage

Prediabetes is common. According to the CDC’s National Diabetes Statistics Report, an estimated 115.2 million U.S. adults had prediabetes in 2023.

For Medicare beneficiaries, the Medicare Diabetes Prevention Program is covered under Part B as a preventive service. CMS says the benefit uses a CDC-approved curriculum and can be delivered in classroom settings, by live virtual distance learning, or in a fully asynchronous online format. Medicare pays for up to 22 sessions for each eligible beneficiary, and current CMS policy allows asynchronous online delivery through December 31, 2029.

Access can still vary in real life. Not every area has the same supplier options, and private insurance, Medicaid arrangements, employer benefits, and local program availability can differ. If you are trying to enroll, ask whether a program is CDC-recognized, whether it is covered by your plan, and whether online participation is available.

Bottom line

This new follow-up does not say lifestyle programs erase chronic disease risk. It says something narrower, and still useful: in people with prediabetes, an intensive lifestyle intervention was associated with a lower long-term risk of developing multiple chronic conditions than placebo.

Reasonable next steps include reviewing your last blood sugar results, asking whether you meet criteria for prediabetes, and checking what structured prevention options are available through your clinician, health system, employer, or insurer. Questions worth asking include:

Do my lab results suggest prediabetes or rising diabetes risk?
Would a structured lifestyle program fit my risk level better than general counseling alone?
Are there CDC-recognized or Medicare-covered options near me or online?
How often should I repeat A1C or fasting glucose testing?
Should we discuss metformin or other prevention options based on my risk factors?

Sources

Editorial note: Weence articles are researched from cited public-health, medical, regulatory, journal, and reputable news sources and may be drafted with AI assistance. They are checked for source support, clarity, and safety guardrails before publication.

This article is for general informational purposes only and is not medical advice. Research findings can be early or incomplete, and health guidance can change. Always talk with a qualified healthcare professional about personal symptoms, diagnosis, medications, vaccines, screenings, or treatment decisions. If you think you may have a medical emergency, call emergency services right away.