October 01, 2021

Prediabetes in older adults: An unclear risk

Evidence shows that prediabetes can be a predictor of whether young or middle-aged adults develop full-blown diabetes in the future. However, recent research published in JAMA Internal Medicine suggests that it may not be a good yardstick for the older population.

Prediabetes becomes increasingly common with age. It is a term used to predict who will develop diabetes and is characterized by hemoglobin A1C or fasting glucose levels that are above the standard range, but not high enough to be considered diabetes. Experts believe that some long-term damage, particularly to the heart, blood vessels and kidneys, can start in the prediabetes stage.

The JAMA study looked at more than 3,000 adults with an average age of about 75 who didn't have diabetes. Depending on what measurement of blood sugar was used, anywhere from 29% to 73% of study participants met the criteria for prediabetes. However, during more than six years of follow-up, fewer than 12% of the older adults considered to have prediabetes progressed to diabetes. More typical was a return to standard blood sugar levels.

Researchers suggest that in older adults, the focus of diabetes prevention should not necessarily use current definitions of prediabetes or emphasize aggressive treatments.

Instead, they recommend focusing on lifestyle changes that promote health and reduce the risk of death: eating healthy foods, exercising regularly, losing excess weight, quitting smoking, and treating high blood pressure and cholesterol with medications, if necessary.

Additional research is likely needed before any major changes are made in prediabetes screening recommendations. Mayo Clinic follows American...