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Few Older Adults With Prediabetes Show Disease Progression

TUESDAY, Feb. 9, 2021 -- Prediabetes may not be a robust diagnostic criteria for predicting diabetes progression among older adults, according to a study published online Feb. 8 in JAMA Internal Medicine.

Mary R. Rooney, Ph.D., M.P.H., from the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues used data from the Atherosclerosis Risk in Communities Study (baseline, 2011 to 2013) to identify 3,412 older adults (mean age, 75.6 years) without diabetes with follow-up through 2017. Different prediabetes definitions were assessed to characterize the risk for progression.

The researchers found that during the 6.5-year follow-up period, there were 156 incident total diabetes cases and 434 deaths. Forty-four percent of participants met prediabetes criteria using glycated hemoglobin (HbA1c) levels of 5.7 to 6.4 percent, while 59 percent met impaired fasting glucose (IFG) criteria (fasting glucose level of 100 to 125 mg/dL). Overall, nearly three-quarters (73 percent) met the HbA1c or IFG criteria, while 29 percent met both the HbA1c and IFG criteria. Among participants with HbA1c-defined prediabetes at baseline, 9 percent progressed to diabetes, 13 percent regressed to normoglycemia (HbA1c <5.7 percent), and 19 percent died. Of those with IFG-defined prediabetes at baseline, 8 percent progressed to diabetes, 44 percent regressed to normoglycemia (fasting glucose level of <100 mg/dL), and 16 percent died. Of those with HbA1c levels <5.7 percent at baseline, 17 percent progressed to HbA1c-defined prediabetes and 3 percent developed diabetes. Of those with fasting glucose levels <100 mg/dL at baseline, 8 percent progressed to IFG-defined prediabetes and 3 percent developed 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," the authors write. "These findings suggest that prediabetes may not be a robust diagnostic entity in older age."

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Posted: February 2021