“For most older patients, the chance of progression from prediabetes to diabetes is not great,” said Robert Lash, chief medical officer of the Endocrine Society. “However, labeling people with prediabetes may make them anxious and anxious.”
Other experts believe it’s important to identify prediabetes, especially if doing so inspires older adults to add more physical activity, lose weight, and eat a healthy diet to help control blood sugar.
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“The diagnosis of prediabetes should always be taken seriously,” said Rudica Busui, president-elect of medicine and science for the American Diabetes Association, which recommends adults 45 and older get screened for prediabetes at least once every three years. The CDC and the American Medical Association make a similar point in “Do I Have Diabetes?” Campaign.
However, many older adults are still not sure what to do if they have been told they have prediabetes. They include Nancy Selvin, 79, of Berkeley, California.
At 5 feet and 106 pounds, Sylvin is a slim ceramic artist and in good physical shape. She takes a vigorous hour-long workout three times a week and eats a Mediterranean-style diet. However, Sylvain has been concerned since she learned last year that her blood sugar was slightly above normal.
“I’m scared of getting diabetes,” she said.
Research shows that more than a quarter of people between the ages of 12 and 19 have prediabetes
Two recent reports on prediabetes in the elderly have increased interest in this topic. Until publication, most studies focused on prediabetes in middle-aged adults, leaving the significance of the condition in older adults uncertain.
A new study by researchers at the CDC, published in April in JAMA Network Open, examined data on more than 50,000 older patients with prediabetes between January 2010 and December 2018. It found that more than 5 percent of these patients progressed to diabetes annually. .
The researchers used a measure of blood sugar levels over time, hemoglobin A1C. Prediabetes is referred to as A1C levels of 5.7 to 6.4 percent, or a fasting plasma glucose test reading of 100 to 125 milligrams per deciliter, according to the Diabetes Association. (This glucose test assesses blood sugar after a person has not eaten anything for at least eight hours.)
It should be noted that the results of the study show that the elderly who are obese and those with prediabetes were at a high risk of developing diabetes. Older blacks, those with a family history of diabetes, lower-income seniors and the elderly were also at risk (6 to 6.4 percent) of the A1C prediabetes group. Men were at slightly higher risk than women.
Busoy said the findings could help caregivers personalize care for older adults.
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They also stress the importance of directing older adults with prediabetes — especially those at higher risk — to lifestyle intervention programs, said Alan Koyama, lead author of the study and an epidemiologist at the CDC.
Since 2018, Medicare has covered the Diabetes Prevention Program, a group of classes offered at YMCA and other community settings designed to help older adults with prediabetes eat healthy, lose weight, and get more active. Research has shown that the prevention program reduces the risk of developing diabetes by 71 percent in people age 60 and older. But only a small part of eligible persons enrolled.
Another study published in the JAMA Internal Medicine last year puts prediabetes into an additional perspective. The study showed that over 6.5 years, less than 12 percent of older adults with prediabetes transitioned to full-blown diabetes. By contrast, a greater portion either died of other causes or returned to normal blood sugar levels during the study period.
“We know it’s common for older people to have moderately elevated glucose levels, but it doesn’t mean the same thing as it might in younger individuals – it doesn’t mean you’ll get diabetes, go blind, or lose weight,” said Elizabeth Selvin, daughter of Nancy Selvin. and one of the authors of the JAMA Internal Medicine study, “Your Leg.” She is also a professor at the Johns Hopkins Bloomberg School of Public Health. “Almost no one develops [diabetes] Elizabeth Selvin said:
“It’s okay to tell older adults with prediabetes to get more exercise and eat carbohydrates more evenly throughout the day,” said Medha Munshi, director of the Diabetes Program in Older People at Harvard Medical School’s Joslin Diabetes Center. “But it is important to educate patients that this is not a disease that will inevitably lead to diabetes and fatigue.”
Many elderly people have slightly elevated blood sugar because they produce less insulin and process it less efficiently. She said that while this is taken into account in clinical diabetes guidelines, it has not been incorporated into pre-diabetes guidelines.
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Aggressive prediabetes treatments, such as metformin, should be avoided, said Victor Montori, an endocrinologist and professor of medicine at the Mayo Clinic. “If you develop diabetes, you will be prescribed metformin. But it does not make sense to give you metformin now, because you may be at risk, to reduce the chance that you will need metformin later.”
Unfortunately, some doctors prescribe medications for older people with prediabetes, and not many spend time discussing the implications of this condition with patients.
That was true for Elaine Husam, 74, of Parkersburg, Virginia, who was upset last summer when she scored 5.8 percent on the A1C test. Hossam’s mother developed diabetes in adulthood, and Hossam feared that this might happen to her as well.
At the time, Hossam was going for exercise five days a week and also walking four to six miles a day. When her doctor advised to “watch what you eat,” Hussam cut out a lot of sugar and carbs in her diet and lost nine pounds. But when she did another A1C test at the beginning of this year, her number dropped only slightly, to 5.6 percent.
“My doctor didn’t have much to say when I asked, ‘Why wasn’t there more change?’ Hossam said.
Experts said fluctuations in test results are common, especially around the lower and upper extremities of the prediabetes range. According to a CDC study, 2.8 percent of older adults with diabetes with A1C levels ranging from 5.7 to 5.9 percent develop diabetes each year.
Nancy Selvin, who learned last year that her A1C level rose to 6.3 percent from 5.9 percent, said she had been trying to lose six pounds without success since getting those test results. Her doctor told Selvin not to worry, but he prescribed a statin to reduce the possibility of cardiovascular complications, since prediabetes is associated with a higher risk of heart disease.
This is consistent with one conclusion of the Johns Hopkins Pre-Diabetes Study last year. “Overall, current evidence suggests that cardiovascular disease and mortality should be the focus of disease prevention in the elderly rather than the development of prediabetes,” the researchers wrote.
Libby Christianson, 63, of Sun City, Arizona, started walking more regularly and eating more protein after learning last summer that her A1C level was 5.7 percent.
“When my doctor said, ‘You have diabetes,’ I was shocked because I always thought of myself as a healthy person,” she said.
“If prediabetes is a kick in the ass to move people into healthier behaviors, I’m fine with that,” said Kenneth Lamm, a geriatrician at the University of California, San Francisco. “But if you’re older, definitely over 75, and that’s a new diagnosis, it’s not something I’m going to worry about. I’m sure diabetes won’t be as important in your life.”
This article was produced by Kaiser Health NewsAnd the A program for the Kaiser Family Foundation, a nonprofit organization that provides information on the nation’s health issues.
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