Other experts believe it’s important to identify prediabetes, especially if this inspires older adults to get more physical activity, lose weight, and eat healthier diets to help bring blood sugar under control.
Still, many older adults aren’t sure what they should be doing if they’re told they have prediabetes. Nancy Selvin, 79, of Berkeley, California, is among them.
At 5 feet tall 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. Yet Selvin has felt alarmed since learning last year that her blood sugar was slightly above normal.
“I’m terrified of being diabetic,” she said.
Two recent reports about prediabetes in the older population are stimulating heightened interest in this topic. Until their publication, most studies focused on prediabetes in middle-aged adults, leaving the significance of this condition in older adults uncertain.
Of note, study results show that obese older adults with prediabetes were at significantly heightened risk of developing diabetes. Also at risk were Black seniors, those with a family history of diabetes, low-income seniors, and older adults at the upper end (6 percent to 6.4 percent) of the A1C prediabetes range. Men were at a slightly higher risk than women.
The findings can help providers personalize care for older adults, Busui said.
They also confirm the importance of directing 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 set of classes offered at YMCAs and in other community settings designed to help seniors with prediabetes eat healthier diets, lose weight, and perform more physical activity. Research has shown that the prevention program lowers the risk of diabetes by 71 percent in people aged 60 and older. But only a small fraction of people eligible have enrolled.
The takeaway?
“Almost no one develops the [diabetes] complications we’re really worried about in younger people.”
Many older people have slightly elevated blood sugar because they produce less insulin and process it less efficiently. While this is factored into clinical diabetes guidelines, it hasn’t been incorporated in prediabetes guidelines, she noted.
“If you get diabetes, you will be prescribed metformin,“ Montori said. ”But it’s just nonsense to give you metformin now, because you may be at risk, to reduce the chance that you’ll need metformin later.”
Unfortunately, some doctors are prescribing medication to older adults with prediabetes, and many aren’t spending time discussing the implications of this condition with patients.
That was true for Elaine Hissam, 74, of Parkersburg, West Virginia, who became alarmed last summer when she scored 5.8 percent on an A1C test. Hissam’s mother developed diabetes in adulthood, and Hissam dreaded the possibility that it would happen to her, too.
At the time, Hissam was going to exercise classes five days a week and walking four to six miles daily as well. When her doctor advised “watch what you eat,” Hissam cut out much of the sugar and carbohydrates in her diet and dropped nine pounds. But when she had another A1C test at the start of this year, it had dropped only slightly, to 5.6 percent.
“My doctor really didn’t have much to say when I asked, ‘Why wasn’t there more of a change?’” she said.
Experts I spoke with said fluctuations in test results are common, especially around the lower and upper ends of the prediabetes range. According to the CDC study, 2.8 percent of prediabetic seniors with A1C levels of 5.7 percent to 5.9 percent convert to diabetes each year.
Nancy Selvin, who learned last year that her A1C level had climbed to 6.3 percent from 5.9 percent, said she’s been trying to lose six pounds without success since getting those test results. Her doctor has told Selvin not to worry, but prescribed a statin to reduce the potential for cardiovascular complications, since prediabetes is associated with an elevated risk of heart disease.
That conforms with one of the conclusions of the Johns Hopkins prediabetes study last year.
“Taken as a whole, the current evidence suggests that cardiovascular disease and mortality should be the focus of disease prevention among 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 percent.
“When my doctor said, ‘You’re prediabetic,’ I was shocked because I’ve always thought of myself as being a very healthy person,” she said.
