prediabetes

Does Prediabetes Predict Diabetes Risk in Older Adults?

Prediabetes in community-dwelling older adults may not be an accurate indicator of diabetes risk, according to the results of a recent study. Death or regression to normoglycemia was a more likely outcome than developing diabetes in this patient population.

To examine this association, the researchers conducted a prospective cohort analysis that utilized data from the 2011-2013 Atherosclerosis Risk in Communities Study. Included were 3412 adults aged 71 to 90 years with prediabetes. Prediabetes was defined as a glycated hemoglobin (HbA1c) level of 5.7% to 6.4% and/or an impaired fasting glucose (IFG) level of 100-125 mg/dL. All participants were followed-up semiannually through 2017. Of the 3412, 2497 participants attended the follow-up visit or died before it occurred.

Overall, there were 156 cases of diabetes and 434 deaths within the 6.5-year follow-up period. Of the total participants, 44% (n = 1490) had HbA1c levels of 5.7% to 6.4%, 59% (n = 1996) had IFG, 73% (n = 2482) met the criteria for HbA1c or IFG, and 29% (n = 1004) met criteria for both HbA1c and IFG.

The results also indicated that:

  • In participants with HbA1c levels of 5.7% to 6.4% at baseline, 9% (n = 97) developed diabetes, 13% (n = 148) regressed to normoglycemia with HbA1c levels <5.7%, and 19% (n = 207) died.
  • In participants with IFG at baseline, 8% (n = 112) developed diabetes, 44% (n = 647) regressed to normoglycemia with FG <100 mg/dL, and 16% (n = 236) died.
  • In participants with HbA1c levels less than 5.7% at baseline, 17% (n = 239) increased to HbA1c levels of 5.7% to 6.4%, and 3% (n = 41) progressed to diabetes.
  • In participants with FG levels less than 100 mg/dL at baseline, 8% (n = 80) increased to IFG (FG, 100-125 mg/dL), and 3% (n = 26) progressed to diabetes.

 

“In this community-based cohort study of older adults, the prevalence of prediabetes was high; however, during the study period, regression to normoglycemia or death was more frequent than progression to diabetes. These findings suggest that prediabetes may not be a robust diagnostic entity in older age.”

—Leigh Precopio

 

Reference:

Rooney MR, Rawlings AM, Pankow JS, et al. Risk of progression to diabetes among older adults with prediabetes. JAMA Intern Med. Published online February 8, 2021. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2775594