Abstract 1: Risk of Progression to Diabetes Among Older Adults with Prediabetes

Risk of progression to diabetes among older adults with prediabetes Rooney MR, Rawlings AM, Pankow JS, et al. JAMA Int Med. 2021;181(4):511-519. doi: 10.1001/jamainternmed.2020.8774.

Prediabetes is a debated diagnosis with different definitions. The purpose of this study was to compare different definitions of prediabetes and the risk of developing this condition in older community-dwelling adults. 

• This was a prospective cohort study of adults without diabetes in the Atherosclerosis Risk in Communities Study. 
• Prediabetes was 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.
• The outcome was incidence of diabetes (determined by one or more of physician diagnosis, glucose-lowering medication use, HbA1c level ≥6.5%, or FG level ≥126 mg/dL). 
• Study participants: N = 3,412, with mean age of 75.6 years, 60% female, and mean follow-up of 6.5 years.
• There were 156 total incidents of diabetes diagnosis and 434 deaths.

PMID: 33555311

EDITOR'S COMMENTARY - Ken Milne, MD 
This study is limited by being observational data. Expanding oral antihyperglycemic agents to those with “pre-disease” increases the market share for pharmaceutical companies. However, we do not have high-quality evidence that treating prediabetic adults with metformin results in an improved patient-oriented outcome (SR Brown, Am Fam Physician 2019). 

BOTTOM LINE: If you make it to your 70s without developing diabetes, it is unlikely you will be diagnosed with diabetes even if you are “prediabetic.”