What does this research mean for the field?

Among older adults, prediabetes is highly prevalent but regression to normoglycemia or death is more frequent than progression to diabetes, suggesting it may not be a robust diagnostic entity in this age group. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

To compare definitions of prediabetes and assess diabetes risk among older adults in a community setting.

February 9, 2021Open Access

Risk of Progression to Diabetes Among Older Adults With Prediabetes

Puntos clave

To compare definitions of prediabetes and assess diabetes risk among older adults in a community setting.
Prospective cohort analysis of 3412 older adults without diabetes from 2011 to 2017.
Participants monitored semiannually and defined prediabetes using HbA1c and impaired fasting glucose levels.
Incident diabetes was recorded through physician diagnosis and lab results.
156 incident diabetes cases occurred over 6.5 years; 9% of those with HbA1c 5.7-6.4% progressed to diabetes.
44% of participants regressed to normoglycemia, indicating a higher occurrence of improvement than progression.
Overall, regression to normoglycemia and mortality were more common than progressing to diabetes.

Resumen

Importance: The term prediabetes is used to identify individuals at increased risk for diabetes. However, the natural history of prediabetes in older age is not well characterized. Objectives: To compare different prediabetes definitions and characterize the risks of prediabetes and diabetes among older adults in a community-based setting. Design, Setting, and Participants: In this prospective cohort analysis of 3412 older adults without diabetes from the Atherosclerosis Risk in Communities Study (baseline, 2011-2013), participants were contacted semiannually through December 31, 2017, and attended a follow-up visit between January 1, 2016, and December 31, 2017 (median range follow-up, 5.0 0.1-6.5 years). Exposures: Prediabetes defined by a glycated hemoglobin (HbA1c) level of 5.7% to 6.4%, impaired fasting glucose (IFG) level (FG level of 100-125 mg/dL), either, or both. Main Outcomes and Measures: Incident total diabetes (physician diagnosis, glucose-lowering medication use, HbA1c level ≥6.5%, or FG level ≥126 mg/dL). Results: A total of 3412 participants without diabetes (mean SD age, 75.6 5.2 years; 2040 60% female; and 572 17% Black) attended visit 5 (2011-2013, baseline). Of the 3412 participants at baseline, a total of 2497 participants attended the follow-up visit or died. During the 6.5-year follow-up period, there were 156 incident total diabetes cases (118 diagnosed) and 434 deaths. A total of 1490 participants (44%) had HbA1c levels of 5.7% to 6.4%, 1996 (59%) had IFG, 2482 (73%) met the HbA1c or IFG criteria, and 1004 (29%) met both the HbA1c and IFG criteria. Among participants with HbA1c levels of 5.7% to 6.4% at baseline, 97 (9%) progressed to diabetes, 148 (13%) regressed to normoglycemia (HbA1c, <5.7%), and 207 (19%) died. Of those with IFG at baseline, 112 (8%) progressed to diabetes, 647 (44%) regressed to normoglycemia (FG, <100 mg/dL), and 236 (16%) died. Of those with baseline HbA1c levels less than 5.7%, 239 (17%) progressed to HbA1c levels of 5.7% to 6.4% and 41 (3%) developed diabetes. Of those with baseline FG levels less than 100 mg/dL, 80 (8%) progressed to IFG (FG, 100-125 mg/dL) and 26 (3%) developed diabetes. Conclusions and Relevance: In this community-based cohort study of older adults, the prevalence of prediabetes was high; however, during the study period, regression to normoglycemia or death was more frequent than progression to diabetes. These findings suggest that prediabetes may not be a robust diagnostic entity in older age.

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