If you’re older and have prediabetes, try to eat better and not worry
“For most older patients, the chance of progressing from prediabetes to diabetes is not that high,” said Robert Lash, the chief medical officer of the Endocrine Society. “Yet labeling people with prediabetes may make them worried and anxious.”
Other experts believe it is important to identify prediabetes, especially if doing so inspires older adults to add more physical activity, lose weight and eat healthier diets to help bring their blood sugar under control.
“Always a diagnosis of prediabetes should be taken seriously,” said Rodica Busui, president-elect of medicine and science at 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 their ongoing “Do I Have Diabetes?” campaign.
Still, many older adults aren’t sure what they should be doing if they’re told they have prediabetes. Nancy Selvin, 79, of Berkeley, Calif., is among them.
At 5 feet 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 have 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.
A new study by researchers at the CDC, published in April in JAMA Network Open, examined data for more than 50,000 older patients with prediabetes between January 2010 and December 2018. Just over 5 percent of these patients progressed to diabetes annually, it found.
Researchers used a measure of blood sugar levels over time, hemoglobin A1C. Prediabetes is signified by 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 evaluates blood sugar after a person hasn’t eaten anything for at least eight hours.)
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 to 6.4 percent) of the A1C prediabetes range. Men were at 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, lose weight and become more active. Research has shown the prevention program lowers the risk of diabetes by 71 percent in people 60 and older. But only a small fraction of people eligible have enrolled.
Another study, published in JAMA Internal Medicine last year, puts prediabetes in further perspective. Over the course of 6.5 years, it showed, fewer than 12 percent of seniors with prediabetes progressed to full-fledged diabetes. By contrast, a larger portion either died of other causes or shifted back to normal blood sugar levels over the study period.
“We know that it’s common in older adults to have mildly elevated glucose levels, but this doesn’t have the same meaning that it would in younger individuals — it doesn’t mean you’re going to get diabetes, go blind, or lose your leg,” said Elizabeth Selvin, daughter of Nancy Selvin and a co-author of the JAMA Internal Medicine study. She is also a professor at Johns Hopkins Bloomberg School of Public Health. “Almost no one develops the [diabetes] complications we’re really worried about in younger people,” Elizabeth Selvin said.
“It’s okay to tell older adults with prediabetes to exercise more and eat carbohydrates evenly throughout the day,” said Medha…
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