Risk of Progression to Diabetes among Older Adults with Prediabetes

Mary R. Rooney, Andreea M. Rawlings, James S. Pankow, Justin B. Echouffo Tcheugui, Josef Coresh, A. Richey Sharrett, Elizabeth Selvin

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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, HbA1clevel ≥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 HbA1clevels of 5.7% to 6.4%, 1996 (59%) had IFG, 2482 (73%) met the HbA1cor IFG criteria, and 1004 (29%) met both the HbA1cand IFG criteria. Among participants with HbA1clevels 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 HbA1clevels less than 5.7%, 239 (17%) progressed to HbA1clevels 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.

Original languageEnglish (US)
Pages (from-to)511-519
Number of pages9
JournalJAMA internal medicine
Issue number4
StatePublished - Apr 2021

Bibliographical note

Funding Information:
Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Department of Health and Human Services, under contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. Research reported in this publication was supported by grants T32HL007024 (Dr Rooney) and K24HL152440 (Dr Selvin) from the NHLBI and grant R01DK089174 from the National Institute of Diabetes and Digestive and Kidney Diseases (Dr Selvin).

Funding Information:
Dr Sharrett reported receiving grants from the Johns Hopkins Bloomberg School of Public Health during the conduct of the study. Dr Selvin reported receiving grants from the National Institutes of Health during the conduct of the study and grants from the National Institutes of Health and the Foundation for the National Institutes of Health outside the submitted work. No other disclosures were reported.

Publisher Copyright:
© 2021 American Medical Association. All rights reserved.

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