Prediabetes: Does Lifestyle Beat Metformin Beyond Diabetes?

For people with prediabetes, the usual advice about weight loss, physical activity, and coaching may matter for more than delaying type 2 diabetes. A June 15, 2026, follow-up study in JAMA of the original U.S. Diabetes Prevention Program found that participants who were originally assigned to an intensive lifestyle program had a lower long-term risk of developing multimorbidity, meaning multiple chronic conditions over time, than those originally assigned to placebo. Participants originally assigned to metformin were not significantly different from placebo for this specific outcome.

That does not mean lifestyle change guarantees protection, and it does not mean metformin has no role. But the new analysis broadens the question many readers ask: if you have prediabetes, can early prevention affect your health beyond diabetes alone?

What the study actually was

This was a long-term follow-up of the original Diabetes Prevention Program, not a brand-new trial that started in 2026. The original study enrolled 3,234 adults at high risk of type 2 diabetes at 27 U.S. sites from 1996 to 1999 and randomly assigned them to intensive lifestyle intervention, metformin, or placebo. For the June 2026 analysis, researchers used linked Medicare claims data through 2021 for 1,173 participants who consented to that follow-up.

That narrower sample matters. The new paper mainly reflects older adults who remained in long-term follow-up and had Medicare-linked data available, not every person with prediabetes in the United States.

What “multimorbidity” means in plain language

Multimorbidity means living with more than one chronic health condition. In real life, that can mean diabetes plus high blood pressure, kidney disease, heart disease, arthritis, or other long-term illnesses that build up over time. This study stands out because it looked beyond whether people later developed diabetes and asked whether early prevention changed the larger pattern of chronic disease later in life.

What the results suggest

Among the participants included in the Medicare-linked analysis, the lifestyle group had a lower rate of developing multimorbidity over about 21 years of follow-up than the placebo group. The JAMA abstract reports a hazard ratio of 0.79 for lifestyle versus placebo, meaning the rate of developing multiple chronic conditions over follow-up was lower in the lifestyle group. For this outcome, the metformin group was not significantly different from placebo.

The NIH summary also said the lifestyle finding remained when diabetes itself was removed from the multimorbidity definition. That matters because it suggests the result was not only driven by whether someone crossed the line into a diabetes diagnosis.

Why readers should not overread one study

This follow-up adds useful long-range evidence, but it is not the last word. Researchers were analyzing a subset of the original trial rather than rerandomizing people 21 years later. People’s medical care, medications, and health behaviors could have changed over time. The analyzed group was also older by the end of follow-up, with a median age of 74, so the findings may not apply the same way to younger adults or to every risk profile.

Just as important, this paper does not show that metformin is bad or useless. It shows that for this particular long-term outcome, accumulating multiple chronic diseases, the original metformin assignment was not significantly better than placebo. Whether metformin makes sense for a given person with prediabetes is still an individual decision that depends on overall risk, lab results, medical history, and access to lifestyle support.

What this means if you have prediabetes

The practical takeaway is lifestyle-first, not lifestyle-only. If you have prediabetes, or think you might, ask a clinician whether you should be tested, how high your risk is, and whether a structured prevention program fits your situation. CDC notes that prediabetes often has no symptoms, which is one reason many people do not know they have it. Risk is higher in people who are age 45 or older, have overweight, have a parent or sibling with type 2 diabetes, had gestational diabetes, or are physically active less than three times a week.

CDC guidance emphasizes realistic targets that have been used in diabetes prevention: losing about 5% to 7% of body weight if you have overweight and getting at least 150 minutes a week of brisk walking or similar activity. For many people, the most useful next step is not trying to do everything alone, but joining a CDC-recognized National Diabetes Prevention Program with trained coaching and structured support.

How to find support in the United States

The National Diabetes Prevention Program is meant to turn broad advice into a real-world plan. The American Diabetes Association’s professional guidance describes it as a structured program built around a CDC-approved curriculum, trained lifestyle coaches, and group support. Depending on where you live, programs may be offered in person, online, or in hybrid formats.

If cost is a concern, ask whether your employer, commercial insurance plan, Medicaid program, or local health system covers or sponsors a CDC-recognized program. Availability can vary by community.

What Medicare readers should check

CMS says the Medicare Diabetes Prevention Program is a covered Part B preventive service for eligible beneficiaries. But eligibility rules, supplier participation, and available formats can vary. If you are on Medicare, confirm that the supplier participates in the Medicare program and verify current eligibility before you enroll.

When to seek medical care sooner

Prediabetes itself often causes no symptoms, but unusual thirst, frequent urination, unexplained weight loss, blurry vision, or persistent fatigue can be signs of diabetes rather than prediabetes. Seek prompt medical care if those symptoms appear, and seek urgent care right away for vomiting, confusion, or signs of severe dehydration.

Bottom line

This June 2026 follow-up does not make lifestyle change easy, and it does not make metformin irrelevant. It does suggest that in this long-running U.S. study, intensive lifestyle intervention was linked to a lower long-term burden of multiple chronic diseases than placebo, while metformin was not significantly different from placebo for that same outcome. For readers with prediabetes, the most reasonable next step is to talk with a clinician about testing, personal risk, and whether a structured prevention program is available to you.

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.