“For most older patients, the chance of progressing from prediabetes to diabetes is not that high,” he said. Robert Lash, the medical director of the Endocrine Society. “However, labeling people with prediabetes can cause concern and anxiety.”
Other experts believe it’s important to identify prediabetes, especially if doing so inspires older adults to add more physical activity, lose weight and eat healthier diets to help control blood sugar.
“A diagnosis of prediabetes should always be taken seriously,” said Rodica Busui, president-elect for medicine and science for the American Diabetes Association, which recommends that adults over 45 get screened for prediabetes at least once every three years. The CDC and the American Medical Association make a similar point in their current “Do I have diabetes? Campaign.
Still, many older adults aren’t sure what they should do if they’re told they have prediabetes. Nancy Selvin, 79, of Berkeley, California, is among them.
At 5 feet 106 pounds, Selvin, a ceramic artist, is slim and physically fit. He takes a rigorous hour-long exercise class three times a week and follows a Mediterranean-style diet. However, Selvin has been alarmed ever since he learned last year that his blood sugar level was slightly above normal.
“I’m terrified that I’m diabetic,” she said.
Two recent reports on prediabetes in the older population have increased interest in this topic. Until its publication, most studies focused on prediabetes in middle-aged adults, leaving the importance of this condition in older adults in doubt.
A new studio by CDC researchers, published in April in JAMA Network Open, examined data from more than 50,000 older patients with prediabetes between January 2010 and December 2018. Just over 5 percent of these patients progressed to diabetes annually, it found.
The researchers used a measure of blood sugar levels over time, hemoglobin a1c. Prediabetes is represented by A1C levels of 5.7 to 6.4 percent, or a fasting plasma glucose test reading of 100 to 125 milligrams per deciliter, according to the diabetes association. (This glucose test checks the level of sugar in the blood after a person has not eaten anything for at least eight hours.)
Of note, the study results show that obese older adults with prediabetes had a significantly increased risk of developing diabetes. Also at risk were African-American older people, those with a family history of diabetes, low-income older people, and older adults at the higher end (6 to 6.4 percent) of the prediabetes A1C range. Men had a slightly higher risk than women.
The findings may help providers personalize care for older adults, Busui said.
They also confirm the importance of directing older people with prediabetes, especially the most vulnerable, to lifestyle intervention programs, said Alain Koyama, the study’s lead author and a CDC epidemiologist.
Since 2018, Medicare has covered the Diabetes Prevention Program, a set of classes offered at YMCAs and other community settings designed to help seniors with prediabetes eat healthier, lose weight and be healthier. active. Research has shown that the prevention program reduces the risk of diabetes by 71 percent in people 60 years of age or older. But only a small fraction of eligible people have signed up.
another study, published in JAMA Internal Medicine last year, puts prediabetes into a broader perspective. Over the course of 6.5 years, it showed that less than 12 percent of older people with prediabetes progressed to full-blown diabetes. By contrast, a larger portion died of other causes or returned to normal blood sugar levels during the study period.
“We know it’s common for older adults to have mildly elevated blood glucose levels, but this doesn’t have the same meaning as it would in younger people; it doesn’t mean you’re going to get diabetes, go blind or lose your leg,” he said. elizabeth selvin, daughter of Nancy Selvin and co-author of the JAMA Internal Medicine study. She is also a professor at the Johns Hopkins Bloomberg School of Public Health. “Hardly anyone develops the [diabetes] complications that really concern us in younger people,” said Elizabeth Selvin.
“It’s okay to tell older adults with prediabetes to exercise more and eat carbohydrates evenly throughout the day,” he said. medha mushi, director of the geriatric diabetes program at the Joslin Diabetes Center, an affiliate of Harvard Medical School. “But it’s important to educate patients that this is not a disease that will inevitably make them diabetic and stress them out.”
Many older people have slightly elevated blood sugar levels because they produce less insulin and process it less efficiently. While this is accounted for in diabetes clinical guidelines, it has not been incorporated into prediabetes guidelines, he said.
Aggressive treatments for prediabetes, such as the drug metformin, should be avoided, he said. Victor Montori, endocrinologist and professor of medicine at the Mayo Clinic. “If you have diabetes, you will be prescribed metformin. But it doesn’t make sense to give him metformin now, because he may be at risk, to reduce the chance that he will need metformin later.”
Unfortunately, some doctors prescribe medication for older adults with prediabetes, and many don’t take the time to discuss the implications of this condition with patients.
That was true for Elaine Hissam, 74, of Parkersburg, W.Va., who was alarmed last summer when she scored 5.8 percent on an A1C test. Hissam’s mother developed diabetes in adulthood, and Hissam feared the possibility that it might happen to her as well.
At the time, Hissam was attending exercise classes five days a week and also walking four to six miles a day. When his doctor advised him to “watch what he eats,” Hissam eliminated much of the sugar and carbohydrates in his diet and lost nine pounds. But when he had another A1C test earlier this year, his number had dropped only slightly, to 5.6 percent.
“My doctor didn’t really have much to say when I asked, ‘Why weren’t there more changes?’ Hissam said.
Experts said fluctuations in test results are common, especially at the lower and upper ends of the prediabetes range. According to the CDC study, 2.8 percent of prediabetic seniors with A1C levels of 5.7 to 5.9 percent become diabetic each year.
Nancy Selvin, who learned last year that her A1C level had risen from 5.9 percent to 6.3 percent, said she has been trying to lose six pounds without success since getting her test results. Her doctor told Selvin not to worry, but she prescribed a statin to reduce the potential for cardiovascular complications, because prediabetes is associated with an elevated risk of heart disease.
That’s consistent with one of the conclusions of last year’s Johns Hopkins prediabetes study. “Taken together, the current evidence suggests that cardiovascular disease and mortality should be the focus of disease prevention among older adults rather than prediabetes progression,” the researchers wrote.
For her part, Libby Christianson, 63, of Sun City, Arizona, began walking more regularly and eating more protein after learning last summer that her A1C level was 5.7 percent.
“When my doctor said, ‘You’re prediabetic,’ I was shocked because I’ve always considered myself a very healthy person,” he said.
“If prediabetes is a kick in the butt to get people into healthier behaviors, I’m fine with that,” he said. Kenneth Lam, a geriatrician at the University of California, San Francisco. “But if you’re older, certainly older than 75, and this is a new diagnosis, it’s not something I worry about. I’m pretty sure diabetes is not going to matter in your life.”
This article was produced by Kaiser Health News, a program of the Kaiser Family Foundation, an endowed nonprofit organization that provides health information to the nation.