Prediabetes May Not Be a Meaningful Diagnosis for those over 70


When physicians identify a patient as having prediabetes, we usually tell them they are at increased risk for actual diabetes in the next few years, and recommend steps that should reduce the risk of progression. A recent study of older folks (average age 76) suggests the risk of progression isn’t very high. In fact the odds are greater for a return to normal blood sugars, or death. The report is a little confusing because the authors used two definitions of prediabetes.

Question:  What is the risk of progression to diabetes among older adults with prediabetes (based on glycated hemoglobin level of 5.7%-6.4%, fasting glucose levels of 100-125 mg/dL, either, or both) in a community-based population?

Findings:  In this cohort study of 3412 older adults, the prevalence of prediabetes (mean [SD] age, 75.6 [5.2] years) was high and differed substantially depending on the definition used, with estimates ranging from 29% for glycated hemoglobin levels of 5.7% to 6.4% and fasting glucose levels of 100 to 125 mg/dL to 73% for either glycated hemoglobin levels of 5.7% to 6.4% or fasting glucose levels of 100 to 125 mg/dL. During the 6 years of follow-up, death or regression to normoglycemia from prediabetes was more frequent than progression to diabetes.

Meaning:  Prediabetes may not be a robust diagnostic entity in older age.

Source: Risk of Progression to Diabetes Among Older Adults With Prediabetes | Geriatrics | JAMA Internal Medicine | JAMA Network

Steve Parker, M.D.

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