Seniors with prediabetes should eat better, exercise, but not worry too much about diabetes

According to the Centers for Disease Control and Prevention, nearly half of older adults — more than 26 million people ages 65 and older — have prediabetes. How concerned should they be?

Not a big deal, some experts say. Prediabetes — a term that refers to above-normal but not extremely high blood sugar levels — isn’t a disease, and it doesn’t mean older adults who have it will inevitably develop type 2 diabetes, they note.

“For most older patients, the odds of going from prediabetes to diabetes are not that high,” says Dr. Robert Lash, medical director of the Endocrine Society, commenting on recent research. “But labeling people with prediabetes can make them anxious and anxious.”

Other experts believe it’s important to identify prediabetes, especially if it inspires older adults to exercise more, lose weight, and eat healthier to control blood sugar.

“A diagnosis of prediabetes should always be taken seriously,” says Dr. Rodica Busui, president-elect of medicine and science at the American Diabetes Association, who recommends that adults age 45 and older be screened for prediabetes at least once every three years. The CDC and the American Medical Association are making a similar point in their ongoing “Do I Have Diabetes?” campaign.

Still, many older adults don’t know what to do when they’re told they have prediabetes. Nancy Selvin, 79, of Berkeley, California, is one of them.

Selvin, a ceramist, is six feet and 106 pounds, slim and in good physical shape. She takes a rigorous one-hour exercise class three times a week and eats a Mediterranean diet. Still, Selvin felt alarmed since learning last year that her blood sugar was slightly above normal.

“I’m terrified of having diabetes,” she said.

Two recent reports on prediabetes in the elderly population are fueling increased interest in this topic. Until their publication, most studies focused on prediabetes in middle-aged adults, leaving uncertain the significance of this condition in older adults.

The latest study by researchers at the CDC, published in April in the JAMA Network Open, examined data on more than 50,000 elderly patients with prediabetes between January 2010 and December 2018. Just over 5% of these patients developed diabetes each year, it found. .

Researchers used a measure of blood sugar levels over time called hemoglobin A1C. Prediabetes is indicated by A1C levels of 5.7% to 6.4% or a fasting plasma glucose test value of 100 to 125 milligrams per deciliter, according to the Diabetes Association. (This glucose test evaluates blood sugar after a person has not eaten anything for at least eight hours.)

Note that study results show that obese older adults with prediabetes had a significantly increased risk of developing diabetes. Also, black seniors, those with a family history of diabetes, low-income seniors, and older adults at the upper end (6%-6.4%) of the A1C prediabetes range were at risk. Men were at a slightly higher risk than women.

The findings could help health care providers personalize care for older adults, Busui said.

They also reaffirm the importance of guiding older people with prediabetes — especially those who are most vulnerable — to lifestyle intervention programs, said Alain Koyama, the study’s lead author and an epidemiologist at the CDC.

Since 2018, Medicare has covered the Diabetes Prevention Program, a series of classes offered at YMCAs and other community settings designed to help seniors with prediabetes eat healthier, lose weight and get more exercise. Research has shown that the prevention program reduces the risk of diabetes by 71% in people aged 60 and older. But only a small part of the people who qualify have registered.

Another study, published last year in JAMA Internal Medicine, helps put prediabetes in a different perspective. Over the course of 6.5 years, less than 12% of seniors with prediabetes progressed to full-blown diabetes. In contrast, a higher proportion either died of other causes or shifted back to normal blood sugar levels during the study period.

The takeaway? “We know it’s common in older adults to have slightly elevated glucose levels, but this doesn’t have the same meaning as it does in younger individuals — it doesn’t mean you’ll get diabetes, go blind, or lose your leg,” said Elizabeth Selvin, daughter of Dr. Nancy Selvin and co-author of the study, who is also a professor at the Johns Hopkins Bloomberg School of Public Health.

“Almost no one develops the [diabetes] complications that we are really concerned about in younger people.”

“It’s okay to tell older adults with prediabetes to exercise more and eat carbohydrates throughout the day,” says Dr. Medha Munshi, director of the geriatric diabetes program at the Joslin Diabetes Center, an affiliate of Harvard Medical School. . “But it’s important to educate patients that this isn’t a disease that will inevitably make you diabetic and make you stressed.”

Many elderly people have slightly elevated blood sugar levels because they produce less insulin and process it less efficiently. While this is factored into clinical diabetes guidelines, it’s not included in prediabetes guidelines, she noted.

Aggressive treatments for prediabetes, such as the drug metformin, should be avoided, according to Dr. Victor Montori, an endocrinologist and professor of medicine at the Mayo Clinic. “If you get diabetes, you will be prescribed metformin. But it’s just nonsense to give you metformin now, because then you run the risk, to reduce the chance that you’ll need metformin later.”

Unfortunately, some doctors prescribe drugs for older adults with prediabetes, and many don’t spend time discussing the implications of this condition with patients.

That was true of Elaine Hissam, 74, of Parkersburg, West Virginia, who was alarmed last summer when she scored 5.8% on an A1C test. Hissam’s mother developed diabetes as an adult, and Hissam feared the possibility of that happening to her.

At the time, Hissam started exercising five days a week and also walking 4 to 6 miles daily. When her doctor advised “watch what you eat,” Hissam cut much of the sugar and carbohydrates in her diet and lost 9 pounds. But when she had another A1C test early this year, it had fallen only slightly, to 5.6%.

“My doctor didn’t have much to say when I asked, ‘Why wasn’t there more change?'” Hissam said.

Experts I spoke to said that fluctuations in test results are common, especially around the lower and upper end of the prediabetes range. According to the CDC study, 2.8% of prediabetic seniors with A1C levels of 5.7% to 5.9% convert to diabetes each year.

Nancy Selvin, who learned last year that her A1C level had risen from 5.9% to 6.3%, said she had tried unsuccessfully to lose 6 pounds since getting those test results. Her doctor has told Selvin not to worry but has prescribed a statin to reduce the risk of cardiovascular complications, as prediabetes is associated with an increased risk of heart disease.

That’s in line with one of the conclusions of the Johns Hopkins prediabetes study last year. “Overall, current evidence suggests that cardiovascular disease and mortality should be the focus of disease prevention in older adults rather than prediabetes progression,” the researchers wrote.

For her part, 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%. “When my doctor said, ‘You are prediabetic,’ I was shocked because I have always considered myself to be a very healthy person,” she said.

“If prediabetes is a kick in the butt to get people to adopt healthier behaviors, that’s fine with me,” says Dr. Kenneth Lam, a geriatrician at the University of California-San Francisco. “But if you’re older, certainly older than 75, and this is a new diagnosis, I wouldn’t worry about it. I’m pretty sure diabetes won’t matter in your life.”

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KHN (Kaiser Health News) is a national editorial that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three major operational programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information on health issues to the nation.

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