A landmark study published in JAMA provides compelling new evidence that healthy lifestyle changes made during midlife can have lasting benefits decades later, reducing the risk of developing multiple chronic diseases as people age.
The study, Lifestyle and Metformin Interventions and Risk of Multimorbidity in Adults with Prediabetes, followed participants from the Diabetes Prevention Program (DPP) and its ongoing Outcomes Study (DPPOS) for more than 20 years. Researchers found that adults with prediabetes who participated in an intensive lifestyle intervention experienced a 21% lower risk of developing multimorbidity—defined as having two or more chronic health conditions—compared with those assigned to a placebo group.
The findings add an important new dimension to one of the most influential prevention studies ever conducted. While previous DPP research demonstrated that lifestyle intervention could delay or prevent the onset of type 2 diabetes, this latest analysis shows that the benefits extend far beyond diabetes prevention and may contribute to healthier aging overall.
“Preventing diabetes is critically important, but preventing the accumulation of multiple chronic diseases as people age may have even broader implications for quality of life, independence, and healthcare costs,” said lead author Marcel Salive, MD, MPH, medical officer in the Division of Geriatrics and Clinical Gerontology at the National Institute on Aging.
The original DPP enrolled adults at high risk for type 2 diabetes between 1996 and 1999 and randomly assigned them to one of three groups: intensive lifestyle intervention, metformin treatment, or placebo. Participants in the lifestyle intervention group worked toward achieving at least 150 minutes of physical activity each week, reducing dietary fat intake, and losing at least 7% of their body weight.
Over the course of two decades, researchers found that participants who adopted and maintained these healthy lifestyle behaviors experienced significantly lower rates of chronic disease combinations involving stroke, chronic kidney disease, heart failure, and chronic obstructive pulmonary disease (COPD). Notably, the reduced risk remained even when diabetes was excluded from the definition of multimorbidity.
The study also underscores the growing burden of chronic disease among older adults. Researchers found that 85% of participants developed at least two chronic conditions during follow-up, highlighting the importance of prevention strategies that can delay or reduce disease accumulation over time.
For Colorado, the findings carry particular significance. Although Colorado consistently ranks among the healthiest states in the nation and performs better than national averages on many health indicators, chronic disease remains a leading public health challenge. Conditions such as hypertension, arthritis, diabetes, depression, and heart disease continue to affect thousands of residents and contribute to rising healthcare costs.
“These findings highlight the long-term value of healthy eating, regular physical activity, and weight management,” said Dana Dabelea, MD, PhD, Associate Dean for Research and Distinguished Professor at the Colorado School of Public Health, Director of the Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, and a co-author of the study. “The dedication of Colorado participants over the past three decades has generated invaluable evidence that will shape future public health policy, research, and practice across our state, helping guide efforts to prevent chronic disease and improve health outcomes for generations to come.”
Colorado researchers have played a key role in the DPP and DPPOS since the study's inception. The Colorado site, led by investigators at the Colorado School of Public Health's LEAD Center, continues to follow approximately 90 participants who have remained engaged in the research for nearly 30 years. Their continued participation has helped create one of the most comprehensive examinations of long-term health outcomes and healthy aging ever conducted.
“As policymakers, healthcare providers, and public health leaders seek solutions to rising chronic disease rates and healthcare costs, the findings offer a powerful reminder: investments in prevention matter,” said Travis Leiker, assistant dean of external relations at ColoradoSPH. Simple lifestyle changes—including regular physical activity, healthier eating habits, and maintaining a healthy weight—can have benefits that last for decades, improving quality of life and reducing the burden of disease as people age.
Read the study: Lifestyle and Metformin Interventions and Risk of Multimorbidity in Adults with Prediabetes, published June 15, 2026, in JAMA.
