“For most older patients, the chance of transitioning from prediabetes to diabetes is not very high,” said Robert Lash, chief medical officer of the Endocrine Society. “But labeling people with prediabetes can make them anxious and worried.”
Other experts believe that identifying prediabetes is important if it encourages older adults to be more physically active, lose weight and eat healthier to help control blood sugar.
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“A diagnosis of prediabetes should always be taken seriously,” said Rodica Busui, president-elect for medicine and science at the American Diabetes Association, which recommends screening for prediabetes every three years for people 45 and older. The CDC and the American Medical Association share a similar point in the “Do I have diabetes?” campaign.
However, many older adults do not know what to do if they are told they have prediabetes. Among them is 79-year-old Nancy Selvin of Berkeley, California.
At 5 feet and 106 pounds, ceramic artist Selwyn is slim and in good physical shape. She takes a vigorous one-hour exercise class three times a week and eats a Mediterranean-style diet. But Selwyn has been concerned since she discovered her blood sugar was slightly above normal last year.
“I’m scared of getting diabetes,” she said.
More than a quarter of 12- to 19-year-olds have prediabetes, the study found
Two recent reports of prediabetes in the elderly population have increased interest in this topic. Until their publication, most studies focused on prediabetes in middle-aged adults, and the significance of this disease in older adults was unknown.
A new study by CDC researchers published in April in the journal JAMA Network Open examined data from more than 50,000 elderly patients with prediabetes between January 2010 and December 2018. More than 5 percent of these patients develop diabetes each year.
The researchers used hemoglobin A1C, which measures blood sugar levels over time. According to the Diabetes Association, prediabetes means an A1C level of 5.7 to 6.4 percent, or 100 to 125 milligrams per deciliter on a fasting plasma glucose test. (This glucose test measures blood sugar after a person has not eaten for at least eight hours.)
Notably, the results of the study show that obese older adults with prediabetes are at a significantly higher risk of developing diabetes. Also at risk were black seniors, people with a family history of diabetes, low-income seniors and seniors living in the prediabetes A1C range (6 to 6.4 percent). Men were slightly more at risk than women.
The findings could help tailor care services for the elderly, Busui said.
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They also confirm the importance of targeting older adults with prediabetes — especially the most vulnerable — to lifestyle intervention programs, said Alain Koyama, lead study author and CDC epidemiologist.
Since 2018, Medicare has covered the Diabetes Prevention Program, a set of classes offered at YMCAs and other community settings to help seniors with prediabetes eat healthier, lose weight, and stay active. Studies show that a prevention program can reduce the risk of diabetes by 71 percent in people 60 and older. However, only a small number of eligible people registered.
Another study, published last year in JAMA Internal Medicine, looks further at prediabetes. Within 6.5 years, it showed, fewer than 12 percent of older adults with prediabetes progressed to full-blown diabetes. Instead, a greater proportion either died of other causes or returned to normal blood sugar levels during the study period.
“We know that in older adults, glucose levels go up a little bit, but it’s not as significant as in younger people — it doesn’t mean you’re going to get diabetes, go blind, or lose your leg,” said Elizabeth Selvin, daughter of Nancy Selvin and author of the JAMA Internal Medicine study. co-author, who is also a professor at the Johns Hopkins Bloomberg School of Public Health. [diabetes] “We’re really concerned about youth challenges,” said Elizabeth Selwyn.
“It’s good to tell older adults with diabetes to get more exercise and eat carbohydrates evenly throughout the day,” said Medha Munshi, MD, director of the Geriatric Diabetes Program at the Joslin Diabetes Center, a Harvard Medical School affiliate. “But it’s important to educate patients that it’s not necessarily diabetes that causes stress.”
Many older people have slightly elevated blood sugar because they produce less insulin and process less of it. Although it is included in the clinical guidelines for diabetes, it is not included in the guidelines for prediabetes, he said.
For people with prediabetes, losing 4 to 6 pounds can reduce the risk of developing diabetes
According to Mayo Clinic endocrinologist and professor of medicine Victor Montori, aggressive prediabetes treatments such as metformin should be avoided. “If you have diabetes, they prescribe you metformin. But giving you metformin now is just nonsense because you may be taking a risk and reducing the chance of needing metformin later.
Unfortunately, some doctors are prescribing medications for older adults with prediabetes, and many don’t take the time to discuss the consequences of the condition with their patients.
That was the case for Elaine Hissam, 74, of Parkersburg, who had an A1C score of 5.8 percent last summer. Hissam’s mother was diagnosed with diabetes as an adult, and Hissam feared that she too would develop it.
At the time, Hissam was exercising five days a week, walking four to six miles each day. When his doctor advised him to “watch what you eat,” Hissam cut out most of the sugar and carbohydrates in his diet and lost nine pounds. But when she had another A1C test earlier this year, her number had dropped only slightly to 5.6 percent.
“Why hasn’t there been another change?” When asked, my doctor really didn’t have much to say. – said Hisam.
Experts say fluctuations in test results are common, especially at the low and high end of the prediabetes range. According to a CDC study, 2.8 percent of prediabetic seniors with an A1C level of 5.7 percent to 5.9 percent will develop diabetes each year.
Nancy Selwyn, who learned her A1C level had risen from 5.9 percent to 6.3 percent last year, said she’s been trying to lose six pounds since getting the test results. Her doctor told Selwyn not to worry, but prescribed a statin to reduce cardiovascular risk because prediabetes is associated with an increased risk of heart disease.
This is consistent with one of the findings of the Johns Hopkins Prediabetes Study last year. “Overall, current evidence suggests that cardiovascular morbidity and mortality, rather than the development of prediabetes, should be the focus of disease prevention among older adults,” the researchers wrote.
For her part, Libby Christianson, 63, of Sun City, Ariz., started walking more and eating more protein last summer after learning her A1C was 5.7 percent.
“When my doctor said, ‘You have diabetes,’ I thought I was a very healthy person, and I was shocked,” she said.
“If prediabetes drives people toward healthier behaviors, I’m all for it,” said Kenneth Lam, a geriatrician at the University of California, San Francisco. “But if you’re older, certainly over 75, and it’s a new diagnosis, it’s not something I would worry about. I’m pretty sure that diabetes doesn’t matter in your life.”
This article was prepared by Kaiser Health News, A program of the Kaiser Family Foundation, a nonprofit organization that provides information on the nation’s health issues.