Image of Elizabeth Selvin, Ph.D., MPH

A diagnosis of prediabetes doesn’t usually forecast full-fledged diabetes in older adults, a new analysis finds.

Investigators examined health outcomes in more than 3,000 study participants with a mean age of 76 in whom prediabetes was diagnosed. The prevalence of prediabetes in the participants’ communities was high, but progression to diabetes during the 6.5-year study period was uncommon, reported Elizabeth Selvin, Ph.D., MPH, of Johns Hopkins, Baltimore. In fact, these older participants were more likely to either regain normal glucose regulation or to die during follow-up than to become diabetic, Selvin and colleagues said.

What’s more, the prevalence of prediabetes in this older age group ranged widely depending on diagnosis criteria. A third (29%) were found to be prediabetic when the condition was defined by glycated hemoglobin levels of 5.7% to 6.4%. But the number jumped to 73% when the diagnosis was made using either glycated hemoglobin levels of 5.7% to 6.4% or fasting glucose levels of 100 to 125 mg/dL.

There is no consensus on which definition is optimal, but either way, little evidence exists that the diagnosis can be used to accurately predict progression in this age group, Selvin wrote. 

“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, especially in the short term — seven years or less,” she said.

The study was published Monday (Feb. 8) in JAMA Internal Medicine.