Zhang JY, Xu YH, Wang ST, Huang Y, Zheng WX, Xiao Y, Yang ZY. Regression to normoglycemia, progression to diabetes, and their association with health outcomes in Chinese adults with untreated prediabetes. World J Diabetes 2026; 17(10): 124090 [DOI: 10.4239/wjd.124090]
Corresponding Author of This Article
Zu-Yao Yang, Assistant Professor, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong 999077, China. zyang@cuhk.edu.hk
Research Domain of This Article
Endocrinology & Metabolism
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research-article
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Zhang JY, Xu YH, Wang ST, Huang Y, Zheng WX, Xiao Y, Yang ZY. Regression to normoglycemia, progression to diabetes, and their association with health outcomes in Chinese adults with untreated prediabetes. World J Diabetes 2026; 17(10): 124090 [DOI: 10.4239/wjd.124090]
Jia-Yue Zhang, Ying Xiao, Faculty of Medicine, Macau University of Science and Technology, Macao 999078, China
Ya-Hui Xu, Shu-Ting Wang, Ying Huang, Wen-Xiao Zheng, Zu-Yao Yang, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
Author contributions: Zhang JY was responsible for data acquisition, formal analysis, and writing the original draft; Zhang JY and Yang ZY conceived and designed the study; Xu YH, Wang ST, Huang Y, Zheng WX, and Xiao Y critically reviewed and revised the manuscript; Yang ZY was responsible for the critical review, revision, editing, and overall supervision of the work; all authors approved the final version for submission.
AI contribution statement: No AI tools were used in this study.
Supported by The Chinese University of Hong Kong Direct Grant, No. 2025.133.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Zu-Yao Yang, Assistant Professor, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong 999077, China. zyang@cuhk.edu.hk
Received: June 8, 2026 Revised: July 21, 2026 Accepted: September 8, 2026 Published online: October 15, 2026 Processing time: 128 Days and 23.8 Hours
Abstract
BACKGROUND
Major guidelines recommend active management of prediabetes, including drug treatment for many individuals, a strategy that could impose a significant burden on primary care systems. Previous studies showed that some individuals with prediabetes could regress to normoglycemia without treatment, but whether this transition was associated with reduced risks of diabetic complications, the ultimate goal of prediabetes management, is less understood.
AIM
To investigate the rates of regression to normoglycemia and progression to diabetes in untreated prediabetes, and preliminarily explore the association of these transitions with risks of cardiovascular disease (CVD), kidney disease and mortality.
METHODS
Participants aged ≥ 45 years with prediabetes in 2011 and untreated during 2011-2015 were identified from The China Health and Retirement Longitudinal Study. The proportions of regression to normoglycemia, persistent prediabetes and progression to diabetes by 2015 were quantified, and their associations with CVD, kidney disease and mortality that occurred during 2015-2020 were investigated by logistic regression analysis, using “persistent prediabetes” as the reference group.
RESULTS
A total of 2461 participants with prediabetes in 2011 were included, of whom 21.5% regressed to normoglycemia and 15.2% progressed to diabetes by 2015. Over the subsequent five years, the progression group showed non-statistically significant higher risks of CVD [adjusted odds ratio (aOR) = 0.97, 95%CI: 0.62-1.52] and kidney disease (aOR = 2.01, 95%CI: 0.90-4.48). For all-cause mortality, the progression group showed a statistically significantly higher risk (aOR = 2.36, 95%CI: 1.18-4.72), corresponding to an attributable risk of 4.35% in that group and 0.66% of the total prediabetes population. Regression to normoglycemia was not statistically significantly associated with risks for the three outcomes during follow-up. Various sensitivity analyses yielded consistent results.
CONCLUSION
Given the modest five-year absolute risk of diabetic complications attributable to progression, prediabetes management needs to be more precise in terms of the timing and target population of intervention.
Core Tip: In the absence of drug treatment over four years, the majority (approximately 85%) of individuals with prediabetes in this study remained stable or regressed to normoglycemia, while 15.2% progressed to diabetes. Progression to diabetes was associated with an increased risk of all-cause mortality in the subsequent five years, but the absolute risk attributable to progression was modest (4.35% of the progression group or 0.66% of the total prediabetes population). The associations between progression and the risks of cardiovascular and kidney disease within 5 years were not statistically significant.
