According to the Center for Disease Control and Prevention, about half of all adults – more than 26 million people aged 65 or older – have pre-diabetes. How concerned should they be?
Not too, said some experts. Prediabetes – a term that refers to above normal but not extremely high blood sugar levels – is not a disease, and does not imply that older adults who have it will inevitably develop type 2 diabetes, they note.
“For most elderly patients, the risk of progressing from pre-diabetes to diabetes is very low,” said Dr. Robert Lash, chief medical officer of the Endocrine Society, in a recent study. “Still, labeling people with pre-diabetes can make them anxious and worried.”
Other experts believe that it is important to diagnose prediabetes, especially if it encourages older adults to eat healthier foods to gain more physical activity, lose weight and control their blood sugar.
“The diagnosis of prediabetes should always be taken seriously,” said Dr. Rodika Busui, president-elect of the American Diabetes Association for Medicine and Science. The CDC and the American Medical Association make a similar point in their ongoing case “Do I have diabetes? “
However, many older adults are not sure what to do if they are told they have prediabetes. Among them is Nancy Selvin, 79, of Berkeley, California.
At 5 feet and 106 pounds, Selvin, a ceramic artist, is slim and in good physical shape. She takes a rigorous hour-long exercise class three times a week and eats a Mediterranean-style diet. However, since learning last year, Selvin has been worried that his blood sugar levels may be slightly higher than normal.
“I’m afraid of being diabetic,” she said.
Two recent reports on prediabetes in the elderly population are stimulating higher interest in the subject. Until their publication, most studies focused on prediabetes in middle-aged adults, leaving the significance of this condition in older adults uncertain.
A new study by CDC researchers, published in April on the JAMA Network Open, examined data from more than 50,000 elderly patients with pre-diabetes between January 2010 and December 2018. Only more than 5% of these patients have developed annual diabetes, it has been found.
Researchers have used a measure of blood sugar levels over time, hemoglobin A1C. According to the Diabetes Association, A1C levels in prediabetes are characterized by 5.7% to 6.4% or fasting plasma glucose test readings by 100 to 125 mg per deciliter. (This glucose test assesses blood sugar when a person has not eaten for at least eight hours.)
Notably, the results of the study show that obese adults with pre-diabetes significantly increased their risk of developing diabetes. Also at risk were black adults with a family history of diabetes, low-income adults and older adults at the upper end of the A1C predisposition range (6% -6.4%). Men were slightly more at risk than women.
Busui said the findings could help providers personalize care for older adults.
They emphasize the importance of conducting lifestyle interventions for older people with prediabetes – especially those at high risk – said Alain Kwama, lead author of the study and an epidemiologist at CDC.
Since 2018, Medicare has covered the Diabetes Prevention Program, a set of classes offered at the YMCA and is designed to help adults with pre-diabetes eat healthier foods, lose weight and gain more physical activity. Studies have shown that prevention programs reduce the risk of diabetes in people aged 60 and over by 71%. But only a small fraction of eligible people have been enrolled.
Another study, published last year in JAMA Internal Medicine, helps keep prediabetes in perspective. By 6.5 years, it shows that less than 12% of older people with pre-diabetes have developed complete diabetes. In contrast, a larger proportion either died of other causes or returned to normal blood sugar levels during the study period.
Takeaway? “We know that mild glucose levels are common in older adults, but that doesn’t mean it’s the same in younger people – it doesn’t mean you get diabetes, go blind or lose your legs,” said Nancy Selvin’s daughter and co-researcher. -Author Elizabeth Selvin She is also a professor at the Johns Hopkins Bloomberg School of Public Health.
“Almost no one develops [diabetes] We young people are really worried about that complexity. “
Dr. Medha Munshi, director of the Geriatric Diabetes Program at the Jocelyn Diabetes Center, affiliated with Harvard Medical School, said: “But it is important to educate patients that this is not a disease that will inevitably make you diabetic and stress you out.”
Many older people have higher blood sugar levels because they produce less insulin and process it less efficiently. Although it is included in the Clinical Diabetes Guidelines, it is not included in the Prediabetes Guidelines, he noted.
Mayo Clinic, an endocrinologist and professor of medicine. According to Victor Montori, invasive treatments for prediabetes, such as metformin, should be avoided. “If you have diabetes, you will be prescribed metformin. But just giving you metformin right now is bad, because you may be at risk to reduce your chances of needing metformin later. ”
Unfortunately, some doctors are prescribing medication to older adults with prediabetes, and many are not spending time discussing the effects of the condition with their patients.
This is true of 74-year-old Elaine Hisam of Parkersburg, West Virginia, who was alarmed when she scored 5.8% on the A1C test last summer. Hisam’s mother was diagnosed with diabetes at a young age, and Hisam feared that this could happen to her as well.
At the time, Hisam exercised five days a week and walked 4 to 6 miles daily. When his doctor advised him to “see what you are eating”, Hisam lost 9 pounds by eliminating a lot of sugar and carbohydrates from his diet. But when it had another A1C test earlier this year, it dropped slightly to 5.6%.
“My doctor didn’t really have anything to say when I asked, ‘Why hasn’t anything changed?’
The experts I spoke to said that fluctuations in test results are common, especially in the lower and upper extremities of the prediabetes range. According to the CDC survey, A1C levels in 2.8% of prediabetic adults convert to diabetes from 5.7% to 5.9% per year.
Nancy Selvin, who learned last year that her A1C level had risen from 5.9% to 6.3%, said she had been trying to lose 6 pounds without success since the test. Her doctor told Selvin not to worry but prescribed a statin to reduce the chances of cardiovascular complications, since prediabetes is associated with a higher risk of heart disease.
This is consistent with a conclusion from last year’s Johns Hopkins Prediabetes Research. “Taken together, the current evidence suggests that heart disease and mortality should be the focus of disease prevention in older adults rather than the progression of pre-diabetes,” the researchers wrote.
For her part, Libby Christianson, 63, of Sun City, Arizona, started walking more regularly and began eating more protein after learning her A1C level was 5.7% last summer. “When my doctor said, ‘You’re prediabetic,’ I was shocked because I always thought of myself as a very healthy person,” he said.
Dr. Kenneth Lam, an aging expert at the University of California-San Francisco, said, “If prediabetes hits the buttocks to lead people to healthy behavior, I’m fine with that.” “But if you’re old, of course over 75, and it’s a new diagnosis, that’s not something I’m going to think about. I’m pretty sure diabetes won’t be important in your lifetime.”
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