What 21 Years Of Data Reveals About Preventing Chronic Disease

Especially for those living with prediabetes.

Hollif

Jun 21, 2026 - 17:15

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What 21 Years Of Data Reveals About Preventing Chronic Disease

Image by Michela Ravasio / Stocksy

June 21, 2026

Most conversations about prediabetes focus on preventing the progression to type 2 diabetes.

But, researchers of a new study 1 followed adults with prediabetes for 21 years, researchers found that an intensive lifestyle program didn't just help prevent diabetes; it significantly reduced the risk of developing multiple chronic diseases at once. And metformin, one of the most commonly prescribed medications for prediabetes, didn't come close to matching those results. Here's what you need to know.

About the study

The research used data from the Diabetes Prevention Program (DPP), a randomized clinical trial that enrolled 3,234 adults at high risk of diabetes across 27 U.S. sites starting in 1996. Participants were split into three groups: one followed an intensive lifestyle program, one took metformin, and one received a placebo. They were then followed for more than two decades through the DPP Outcomes Study (DPPOS), an observational follow-up that tracked long-term health outcomes through 2021.

For this analysis, researchers focused on 1,173 participants with available Medicare data. The group was mostly older adults (median age 74 years) and 68% were female. The main question was, how many people in each group went on to develop multiple chronic conditions over the course of their lives?

Lifestyle cut the risk of multiple chronic diseases; metformin didn't

By the end of the follow-up period, 85% of all participants had developed at least two chronic conditions, with most people accumulating around five. But the rates differed meaningfully depending on which group they'd been in.

In the lifestyle group, 82% developed multiple chronic conditions. In the metformin group, it was 85%. In the placebo group, 87%.

While the absolute difference appears modest, the lifestyle group's advantage was statistically meaningful. After adjusting for relevant factors, they had a 21% lower risk of developing multimorbidity over the follow-up period. That held up even when diabetes was removed from the equation.

For the most costly pairs of conditions, the lifestyle group fared even better. They were roughly 43% less likely to develop those combinations than the placebo group. Metformin, by contrast, showed no significant difference from placebo.

Why lifestyle had the edge

The lifestyle intervention in the DPP wasn't a simple pamphlet about eating better. It was a structured, ongoing program built around three goals: losing around 7% of body weight, getting at least 150 minutes of moderate physical activity per week, and improving overall eating habits.

Participants received continued support throughout the study, including booster sessions offered to the lifestyle group twice a year during the follow-up phase.

All participants (not just the lifestyle group) were offered quarterly lifestyle classes until 2014. This means the placebo and metformin groups also received some lifestyle support, which makes the lifestyle group's advantage even more notable since the gap persisted despite that shared exposure.

What about metformin?

Metformin works by targeting one specific mechanism: it reduces the amount of glucose the liver releases into the bloodstream. That's useful for blood sugar control. However, lifestyle changes affect nearly every system in the body at once. They improve how cells respond to insulin, reduce chronic inflammation, support heart health, and shift metabolic function in ways a single medication can't replicate.

Daily habits that lower your chronic disease risk

The lifestyle pillars from the DPP translate directly into daily habits that support metabolic health and may reduce long-term disease risk:

Move consistently: The program targeted 150 minutes of moderate activity per week (think brisk walking, cycling, or swimming). Adding strength training is a smart move too, since building muscle improves how your body uses insulin and supports metabolic health as you ageEat for blood sugar stability: Fiber-rich foods (vegetables, legumes, whole grains) slow how quickly glucose enters your bloodstream and support a healthy gut. Cutting back on ultra-processed foods and added sugars is one of the most impactful changes you can makeAim for modest, sustainable weight loss: The DPP targeted roughly 7% of body weight, not a dramatic transformation, but enough to meaningfully shift your metabolic riskPrioritize sleep: Poor sleep disrupts how your body regulates blood sugar and increases inflammation, two of the key drivers of chronic disease. Seven to nine hours of quality sleep is a genuine health interventionManage stress: Chronic stress raises cortisol, which in turn raises blood sugar and promotes fat storage around the abdomen. Regular movement, breathwork, and adequate rest all help keep your stress response in check

The takeaway

Among adults with prediabetes, those who committed to an intensive lifestyle program were significantly less likely to accumulate multiple chronic conditions over two decades. Metformin, despite being a widely used and evidence-backed medication, didn't produce the same result; lifestyle change operates on a different level, addressing the root causes of chronic disease in a way that ripples across body systems and compounds over time.