How Meaningful Is Prediabetes for Older Adults?
A few years ago, routine lab tests showed that 65-year-old clinical social worker Susan Glickman Weinberg in Los Angeles had a 5.8 percent reading of hemoglobin A1c, barely above normal.
“It’s supposed to be prediabetes,” his trainee told him. A1C measures how much sugar is circulating in the blood sugar over time. If his results reached 6 percent – still below the number defining diabetes, which is 6.5 – his doctor said he would recommend the widely prescribed drug manifestin.
“I thought maybe I would get diabetes, was very upset,” recalls Ms. Weinberg, who was heard as a child talking to relatives about “this mysterious terrible thing.”
She was already taking two blood pressure medications, a statin for cholesterol and an osteoporosis drug. Did he really need another prescription? He also worried, about the reported time of tainted imported drugs. He did not even know what prediabetes meant, or how soon it could cause diabetes.
“I felt like Patient Zero,” he said. “There were too many unknowns.”
Now, there are fewer unknowns. A longitudinal study of older adults, Published online in this month in the journal JAMA Internal Medicine, provides some answers in the midst of a very common condition known as prediabetes.
Researchers found that over many years, older people who were reportedly prediabetic were more likely to have their blood sugar levels normalized than their diabetes progression. And he was less likely to die during the follow-up period than his peers with normal blood sugar.
“In most older adults, pre-diabetes may not be a priority,” said Elizabeth Selwyn of the Johns Hopkins Bloomberg School of Public Health and senior author of the study.
Prediabetes, rarely discussed as a condition from 15 years ago, refers to a blood sugar level that is higher than normal but has not crossed the threshold in diabetes. It is usually defined by a hemoglobin A1C reading a fasting glucose level of 5.7 to 6.4 percent or 100 to 125 mg / dL; In mid-life, it can exacerbate serious health problems.
A diagnosis of prediabetes means that you are more likely to develop diabetes, and “that leads to thrift disease”, Drs. Said Kenneth Lam, a pediatrician at the University of California, San Francisco, and a writer An editorial with study. “It damages your kidneys, your eyes and your veins. It causes heart attack and stroke, ”he said.
But for an older adult, just changing high blood sugar levels is a different story. Those horrific consequences take years to develop, and many people in their 70s and 80s will not live long enough to encounter them.
That fact has been generated Debate of years. Are older people with slightly above-normal blood sugar readings – the pancreas producing less insulin in life since a recurrent event – taking action, as urged by the American Diabetes Association?
Or does labeling people already a normal part of “medical” aging, causing unnecessary anxiety for people already experiencing their health problems?
Dr. Selwyn and his colleagues analyzed the findings of an ongoing national study of heart risk that began in the 1980s. When 3,412 of the participants showed up for their physical and laboratory tests between 2011 and 2013, they had reached 71 to 90 years of age and had no diabetes.
However, prediabetes was a major disease. About three-quarters qualify as prediabetic, either based on their A1C or fasting blood sugar levels.
These findings showed 2016 study Pointing out that a popular online risk test created by the Centers for Disease Control and Prevention and the American Diabetes Association called doihaveprediabetes.org, Almost everyone over 60 would be deemed as prediabetic.
A in 2010 CDC Review Report 9 to 25 percent of people with A1C of 5.5 to 6 percent will develop diabetes in five years; So 25 to 50 percent would be those with A1C readings of 6 to 6.5. But those estimates were based on a middle-aged population.
When dr. Selwyn and his team looked at what exactly happened five to six years later with their chronic prediabetic cohort, with only 8 or 9 percent developing diabetes, depending on the definition used.
A much larger group – 13 percent whose A1C levels were high and 44 percent of them had prediabetic fasting with blood sugar – actually saw their readings return to normal blood sugar levels. ()A swedish study Similar results were found.)
Sixteen to 19 percent had died, about the same proportion as those without prediabetes.
“We’re not seeing much risk in these individuals,” Dr. Selwyn said. “Older adults may have complex health problems. Those who spoil the quality of life should concentrate, not raise blood sugar. “
A health researcher at Tufts Medical Center in Boston and lead author of the 2016 study, Dr. Saeed Shahraj praised the new research. “The data is really strong,” he said. “The American Diabetes Association should do something about it.”
It can be said, the Chief Scientist and Medical Officer of ADA Drs. Robert Gabbay. The organization currently recommends “at least annual monitoring” for people with prediabetes. Lifestyle modification program Obesity has been shown to reduce health risks and perhaps metformin for those under 60.
Now the Association’s Professional Practice Committee will review the study, and “it may make some adjustments to the way we think about things,” Drs. Gabbay said. He said that among older people, which was retrospective, “their risk may be smaller than we thought.”
Said to afflict one-third of the United States population, who insist on treating pre-diabetes, suggests that first-line treatment involves learning healthy behaviors that more Americans should adopt anyway : Weight loss, smoking cessation, exercise and healthy eating.
“I have diagnosed many patients with prediabetes, and this is what drives them to change,” Dr. Gabbay said. “They know what they should do, but they need something to kick into gear.”
Geriatrics disagree. “It is unprofessional to mislead people, to inspire them out of fear of something that is not really true,” Dr. Lam said. “We are tired of being afraid of all things.”
He and Dr. Sei Lee, co-author of the editorial with the new study and a fellow pediatrician at the University of California, San Francisco, argues for a case-by-case approach in older adults – especially if their children would be diagnosed with prediabetes. Over the cookie.
Dr. Lam said that for a patient who is weak and vulnerable, “you are likely to deal with other problems.” “Don’t worry about this number.”
A very healthy 75-year-old 75-year-old can face more subtle decisions. He can never progress to diabetes; She may already follow recommended lifestyle modifications.
Ms. Weinberg, now 69, sought help from a nutritionist, changed her diet to emphasize complex carbohydrates and proteins, and began to walk more and climb stairs instead of taking a lift. She sheds 10 pounds. She did not need to lose. In 18 months, his barely elevated A1C reading dropped to 5.6.
Her friend Carol Jacoby, 71, who lives in Los Angeles, received a similar warning around the same time. Her A1C was 5.7, defined as the lowest number of prediabetic, but her trainee immediately prescribed metformin.
Ms. Jacoby, a retired fund-diabetic with no family history of diabetes, felt unrelated. She felt that she could lose a little weight, but she had normal blood pressure and an active life that involved a lot of walking and yoga. After trying the medicine for a few months, she stopped.
Now, neither woman has prediabetes. Although Ms. Jacoby did not do much to lower her blood sugar, and has gained a few pounds during the epidemic, her A1C has fallen to normal levels.