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Persons older than 60 years with prediabetes are more likely to become normoglycemic than to develop diabetes or die
Clinical Question
What is the natural history of prediabetes in adults older than 60 years?
Bottom line
In this cohort study, older persons with prediabetes were more likely to become normoglycemic than to develop diabetes or to die. 1b
Reference
Study design: Cohort (prospective)
Funding: Government
Setting: Population-based
Synopsis
These authors analyzed data from the English Longitudinal Study on Ageing, which is a prospective and nationally representative cohort of men and women living in England. The authors categorized 2027 adults older than 60 years who did not have diabetes at baseline by whether or not they had prediabetes (defined as a glycohemoglobin level between 5.7% and 6.4% or a fasting glucose level between 5.6 and 7.0 mmol/L [100–125 mg/dL]). The authors don’t report how often the participants were assessed, but the patients were followed up for 8 years. The average age of the participants was 70.6 years and 55% were women. Among the participants classified as normoglycemic at baseline (glycohemoglobin < 5.7%), 2.3% developed diabetes and 9.8% died (incidence rates: 3.5 per 1000 person years and 13.7 per 1000 person years, respectively). Among the participants with prediabetes based on glycohemoglobin, 12.9% developed diabetes, 11.6% died (incidence rates: 19.6 per 1000 person years and 16.8 per 1000 person years, respectively), and 37.6% became normoglycemic. Of those with prediabetes based on fasting glucose levels, 15.6% developed diabetes, 13.8% died (incidence rates: 23.8 per 1000 person years and 19.0 per 1000 person years, respectively), and 58.2% became normoglycemic. After adjusting for age and sex, compared with being normoglycemic, having prediabetes by either parameter or its permutations was associated with a higher risk of developing diabetes (hazard ratio range: 2.94 - 41.0). Additionally, compared with being normoglycemic, having prediabetes based on fasting glucose and the combination of fasting glucose plus glycohemoglobin was associated with an increased risk of death (1.47 and 1.65, respectively). Regardless, older persons with prediabetes are more likely to become normoglycemic than to develop diabetes or die.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Veronese N et al, Risk of progression to diabetes in older p
It's time to retire the term "prediabetes" when talking about or to older people.
An optimistic bit of information re:Type 2 Diabetes
Pre diabetes does not advance to Diabetes in older patients. Thanks for this important information .
Prediabetes and progression or not
Different labs have different cut offs for normal for fasting glucose and A1C, and what we call diabetes or prediabetes can be a bit arbitrary at the edge of normal. Are we defining normal incorrectly? How many of the patients who did not progress were in the lower range of pre-diabetes? How many in the upper range of pre-diabetes did or did not progress? A little subgroup analysis based on the ranges would be interesting.
prediabetic pts over age 60
more likely to become normoglycemic than diabetic