1. Older adults with prediabetes were more likely to regress to normoglycemia or pass away than progress to diabetes.
2. Prediabetes may be a weak indicator of risk for diabetes among older adults.
Evidence Rating Level: 2 (Good)
Prediabetes is known as a risk factor for progression to diabetes, often used to identify at-risk individuals. However, the progression of prediabetes among older adults is still unclear and may not be diagnostically robust. This prospective cohort study of 3,412 older adults without diabetes (M [SD] age = 75.6 [5.2] years, 60% female, 17% Black) from the Atherosclerosis Risk in Communities Study (baseline 2011-2013) sought to characterize risks of prediabetes and diabetes in older age. All participants were contacted semiannually through 2017, including a final follow-up in 2016 or 2017. Prediabetes was defined by a glycated hemoglobin (HbA1C level between 5.7% and 6.4% and impaired fasting glucose (IFG) level was an FG level of 100-125mg/dL. The main outcome of this study was incident total diabetes. Of the 3,412 initial participants without diabetes, 2,497 attended follow-up or passed away. Over the course of the 6.5 years, there were 156 incident total diabetes cases and 434 deaths. Approximately 44% had HbA1C levels in the diagnostic range and 59% had IFG, and 73% met either the IFG or HbA1C criteria – 29% met both criteria. Those with prediabetes based on HbA1C at baseline, 9% progressed to diabetes. A total of 13% regressed to normoglycemia and 19% passed away. Of participants with baseline IFG, 8% progressed to diabetes, while 44% regressed to normoglycemia and 16% passed away. Of participants who did not have prediabetes based on HbA1C and FG levels, 17% and 8% progressed to prediabetes, respectively, and 3% of each of these groups progressed to diabetes. Overall, this study suggests that, while the prevalence of prediabetes was relatively high, it was more common for participants to regress to normoglycemia or pass away than it was to progress to diabetes. Thus, this risk factor may not serve as a strong diagnostic predictor among older adults.
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