Why improving LE8 scores could save young adults from diabetes

Young adults who upheld healthier LE8 habits, especially weight control, activity, and sleep, were far more likely to reverse prediabetes, revealing a critical chance to halt diabetes before it begins.

Study: Life’s essential 8 and risk of progression to diabetes among young adults with prediabetes. Image Credit: Yuriy Golub / Shutterstock

In a recent study published in the journal Scientific Reports, researchers examined how LE8 cardiovascular health (CVH) scores relate to diabetes progression risk among young adults with prediabetes.

Background

Prediabetes affects more than one in three adults globally and often precedes type 2 diabetes mellitus (T2DM), a condition linked to heart disease, kidney failure, and premature mortality.

The AHA developed LE8, a composite of eight modifiable factors: diet, physical activity (PA), nicotine exposure, sleep health, body mass index (BMI), blood lipids, blood pressure (BP), and blood glucose, to assess CVH.

While high LE8 scores correlate with lower cardiovascular disease (CVD) risk, evidence specifically examining longitudinal LE8 trajectories and diabetes progression in young adults with prediabetes remains limited.

Clarifying how sustained or declining CVH patterns influence progression risk is important for prevention.

About the Study

Researchers analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal cohort tracking 5,116 Black and White adults aged 18–30 years across four United States (U.S.) cities, Birmingham, Chicago, Minneapolis, and Oakland, since 1985.

The present analysis included data from Year 7 through Year 30, during which glycemic and LE8 measures were consistently recorded. Prediabetes was defined as impaired fasting glucose (IFG; fasting glucose 100–125 mg/dL) and, in some analyses, by additional criteria of impaired glucose tolerance (IGT) or hemoglobin A1c (HbA1c 5.7–6.4%).

Diabetes progression was defined as fasting glucose ≥126 mg/dL and/or diagnostic HbA1c or oral glucose tolerance test (OGTT) results, or a subsequent self-reported diagnosis.

Each LE8 component, diet, PA, nicotine exposure, sleep health, BMI, blood lipids, BP, and blood glucose, was scored 0–100 following AHA guidelines.

Composite CVH scores were categorized as ideal, moderate, or poor. Logistic regression models adjusted for age, sex, and race estimated the association between LE8 scores and diabetes progression.

Study Results

Among 3,026 young adults, 974 had prediabetes (average age 43 ± 7 years; 39% women) and 2,052 had steady normal blood sugar, also called euglycemia (average age 32 ± 4 years; 63% women). Over about 13 years, people with prediabetes followed three paths: 34% developed diabetes, 28% stayed prediabetic, and 38% returned to normal glucose levels.

When prediabetes was defined by all three tests, IFG, HbA1c, and IGT, the pattern was stronger: 56% progressed to diabetes, 11% stayed prediabetic, and 33% moved back to normal.

Using LE8, which combines eight factors like diet, PA, nicotine exposure, sleep, BMI, blood lipids, BP, and blood glucose, the group that progressed to diabetes started with the lowest average score (57) compared with those who stayed prediabetic (65) or returned to normal (65). Their scores also dropped the fastest over time.

Looking at individual parts, BMI, BP, blood lipids, blood glucose, and PA worsened in all groups, while nicotine exposure improved slightly.

By subgroup, women and Black participants who progressed had the lowest BMI and PA scores with the steepest declines; men and Black participants showed the greatest BP declines and the lowest diet scores; and women and Black participants had the lowest sleep scores at Year 15 that improved by Year 20.

The numbers show a strong protective effect of better LE8 scores. People with ideal LE8 scores had up to a 90% lower odds of progression (corresponding to an OR of 0.06; 95% CI 0.02–0.13) compared with those with poor scores (p < 0.0001).

Even moderate scores cut risk by 68% (OR 0.32; 95% CI 0.22–0.46; p < 0.0001). Among the eight parts, BMI stood out: an ideal BMI was linked to an 80% lower risk (OR 0.20; 95% CI 0.13–0.28; p < 0.0001). Ideal or moderate BP, PA, and sleep were also protective (OR 0.29–0.59; p < 0.05).

These results show that prediabetes can be reversed and that improving modifiable habits can shift the path away from diabetes. Young adults with higher LE8 scores were more likely to keep or regain normal glucose levels.

Persistent race- and sex-related differences in LE8 trajectories were observed, underscoring contributions from biological factors and social determinants, without directly quantifying a uniquely higher progression rate for any subgroup.

Compared with older studies such as the Diabetes Prevention Program and the Multi-Ethnic Study of Atherosclerosis, the CARDIA group had lower yearly progression rates (2.2–4.4%), likely because participants were younger and started with lower metabolic risk, and due in part to differences in study design.

However, the study’s findings should be interpreted in light of several limitations, including reliance on self-reported lifestyle factors, diet and sleep data collected only twice across follow-up, potential HbA1c variation by race, and incomplete medication tracking over time.

Conclusions

This study highlights that maintaining optimal CVH through balanced diet, regular PA, adequate sleep, and healthy body weight is associated with substantially lower odds of progression from prediabetes to T2DM.

Ideal LE8 scores were linked to up to 90% lower risk of developing diabetes, with BMI as the strongest component and BP, PA, and sleep emerging as key protective factors.

The results support public health efforts to improve cardiometabolic well-being in young adults, especially among women and racial minorities at greater risk.

Promoting early lifestyle interventions may help reverse prediabetes and decrease the lifelong burden of diabetes.