The Association Between Reversion of Prediabetes to Normoglycemia and Incident Cardiovascular Disease and Mortality: A Systematic Review and Meta-Analysis
In brief
Returning to normal glucose cuts cardiovascular events by about a quarter
A meta-analysis of seven cohort studies involving 71,000 adults found that people who reversed prediabetes to normoglycemia experienced roughly a 28% lower risk of major cardiovascular events and a 31% lower risk of cardiovascular death compared with those who remained prediabetic. The benefit did not extend to overall mortality, and the observational data and wide prediction interval mean the finding should be interpreted cautiously.
- Journal
- Canadian journal of diabetes (Q1)
- Published
- 14 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Naseem Eisa, Omar Barood
- PMID
- 42600933
- DOI
- 10.1016/j.jcjd.2026.08.003
Why clinicians should know about it
- Picked for Internal Medicine (top studies of the week, 16 August 2026): Systematic review of prediabetes reversion, not acute care
- Picked for Epidemiology (paper of the day, 15 August 2026).
Abstract
BACKGROUND: Prediabetes affects approximately 470 million adults worldwide and is an established risk factor for cardiovascular disease. Whether reversion from prediabetes to normoglycemia reduces cardiovascular risk remains uncertain. We conducted a systematic review and meta-analysis to quantify this association with major cardiovascular events, cardiovascular mortality, and all-cause mortality. METHODS: We searched PubMed, Embase, CENTRAL, Web of Science, and Scopus through February 2026 for cohort studies and post-hoc analyses of randomized trials comparing cardiovascular outcomes in adults who reverted from prediabetes to normoglycemia versus persistent prediabetes. Hazard ratios were pooled using a DerSimonian-Laird random-effects model, with Hartung-Knapp-Sidik-Jonkman (HKSJ) sensitivity analysis. Heterogeneity was assessed using I2. Publication bias was evaluated using Egger's test. RESULTS: Seven studies (71,143 participants; follow-up 2-30 years) were included. Reversion to normoglycemia was associated with significantly lower composite cardiovascular events (HR 0.72, 95% CI 0.57-0.90; P = 0.004; I2 = 76.1%) and cardiovascular mortality (HR 0.69, 95% CI 0.51-0.95; P = 0.023; I2 = 65.5%). No significant association was found for all-cause mortality (HR 0.95, 95% CI 0.88-1.02; P = 0.169). The 95% prediction interval for the primary outcome ranged from 0.37 to 1.39. Leave-one-out sensitivity analysis confirmed result stability. Egger's test showed no publication bias (P = 0.36). CONCLUSION: Reversion from prediabetes to normoglycemia is associated with significant reductions in cardiovascular events and cardiovascular mortality, supporting early identification and management of prediabetes as a cardiovascular prevention strategy. The observational nature of the evidence and wide prediction interval warrant cautious interpretation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.