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How Significant Is Pre-Diabetes For Older Adults?

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A few years ago, routine lab tests showed that Susan Glickman Weinberg, then a 65-year-old Los Angeles clinical social worker, had a hemoglobin A1C reading of 5.8 percent, which is not above normal.

“This is a precursor,” the internologist told him. A1C measures how much sugar is circulating in the blood over time. If his results were as high as 6 percent, which is still lower than the 6.5 diabetes mark, his doctor said he would recommend the widely prescribed metformin drug.

“The thought that I might get diabetes was very sad,” recalled Ms. Weinberg, who heard her talk about relatives as a child, saying “this mysterious terrible thing.”

He was already taking two blood pressure medications, one for cholesterol and one for osteoporosis. Did he really need another prescription? He was also concerned about reports of contaminated imported drugs. He was not even sure what prediabetes meant or how quickly it could lead to diabetes.

“I was feeling sick,” he said. “There were many unknowns.”

There are fewer unknowns now. A longitudinal study of older adults, published online this month in the journal JAMA Interior Medicine, provides some answers to the fact that a very common intermediate condition is known as precursor.

The researchers found that within a few years, older people who were presumably pre-diabetic were much more likely to have normalized blood sugar levels than those with diabetes. And they were less likely to die later than their normal blood sugar peers.

“Prediabetes probably shouldn’t be a priority for most older adults,” said Elizabeth Selvin, lead author of the Baltimore School of Public Health epidemiologist at the Hopkins Bloomberg School of Public Health in Baltimore.

Prediabetes, which was rarely discussed 15 years ago, refers to high blood sugar levels that are above normal but have not crossed the diabetes threshold. It is usually characterized by a hemoglobin A1C reading of 5.7 to 6.4 percent or a maintenance glucose level of 100 to 125 mg / dL; In middle age, it can cause serious health problems.

“Being diagnosed with prediabetes means you are more likely to have diabetes,” said Kenneth Lam, a senior physician at the University of California, San Francisco, who co-authored the study. “It damages the kidneys, the eyes and the nerves. “It causes a heart attack stroke,” he said.

But for an older adult who simply has high blood sugar, that’s a different story. It takes years for these terrible consequences to develop, and many people in their 70s and 80s will not live long enough to face them.

That fact has sparked years of debate. Should older people have slightly lower blood sugar levels, which often occur because the pancreas produces less insulin later in life, as advised by the American Diabetes Association?

Or does labeling people with pre-diabetic disease just “cure” the normal part of aging, creating unnecessary anxiety for those who are already overcoming many health problems?

Dr. Selvin and his colleagues analyzed the results of an ongoing national cardiovascular risk study that began in the 1980s. When 3412 of the participants underwent their physical laboratory tests between 2011 and 2013, they reached the age of 71-90 without diabetes.

Prediabetes, however, were widespread. Nearly three-quarters were classified as pre-diabetic based on their A1C or fasting blood glucose levels.

These findings reflect a 2016 study that found that a popular online risk test developed by the American Diabetes Association’s Centers for Disease Control and Prevention, called doihaveprediabetes.org, predicts almost everyone over the age of 60.

A 2010 CDC study found that 9-25 percent of people with 5.1 to 6 percent of A1Cs would develop diabetes within 5 years. so will 25 to 50 percent of the 6 to 6.5 percent of A1C readers. But those estimates were based on the middle-aged population.

When Dr. Selvin and his team looked at what actually happened to their old pre-diabetic group 5-6 years later, only about 8 or 9 percent developed diabetes, depending on the definition used.

A much larger group, 13 percent of those with elevated A1C levels 44 44 percent of those with predictive blood glucose, actually saw the readings return to normal blood sugar levels. (A Swedish study found similar results).

16 to 19 percent died, about the same proportion as those without prediabetes.

“We do not see much risk in these individuals,” said Dr. Selvin. “Older people can have serious health problems. “Those who impair the quality of life should focus, not high blood glucose.”

Dr. Saeed Shahraz, a health researcher at Tufts Medical Center in Boston and lead author of the 2016 study, praised the new study. “The data is really strong,” he said. “The American Diabetes Association needs to do something about it.”

That’s right, says Dr. Robert Gabay, Dr.’s chief scientific and medical director. The organization currently recommends “at least annual monitoring” for people with preeclampsia, citing lifestyle changes that have been shown to reduce health risks, perhaps metformin, for those over 60 years of age.

The Association’s Practice Committee will now review the study, “which may lead to some adjustments in our thinking,” said Dr. Gebbay. “Among older people who are considered to be pre-diabetic, ‘their risk may be lower than we thought,'” he added.

Advocates for the Stress of Defenders, who say they affect one-third of the U.S. population, say that first and foremost, treatment includes teaching healthy behaviors that more Americans should accept. Weight loss, smoking cessation, exercise և healthy eating. ,

“I have diagnosed a number of patients with prediabetes, and that has prompted them to change,” said Dr. Gabbay. “They know what they have to do, but they need something to hit their clothes.”

Ger therapists are not inclined. “It is unprofessional to mislead people into motivating them for fear of something that is not really real,” said Dr. Lam. “We are all tired of being scared of things.”

Dr. Sei Lee, co-author of the new study with the senior physician at the University of California, San Francisco, argues for a separate approach for older adults, especially if a diagnosis of preeclampsia leads their children to become disgusted with each cookie.

For an easily vulnerable patient, “you are probably dealing with a number of other issues,” said Dr. Lam. “Do not worry about this number.”

A very healthy 75-year-old man who could have lived “for 20 years is facing a more subtle decision.” He may never have diabetes. he can follow the proposed changes in life.

Now 69-year-old Weinberg has sought help from a nutritionist, changed her diet, focusing on complex carbohydrates – proteins – instead of taking elevators, started walking more, climbing stairs. He lost 10 pounds, which he did not need to lose. In just 18 months, A1C’s barely readable reading fell to 5.6.

His friend Carol Obi Akobi, 71, who also lives in Los Angeles, received a similar warning at about the same time. Her A1C was 5.7, the lowest number defined as pre-diabetic, but her intern immediately prescribed metformin.

Mrs. Jacob, a retiree with no family diabetes, was worried. He realized that he could lose some weight, but he had normal blood pressure, an active life that included a lot of walking, yoga. After several months of trying the drug, he stopped.

No woman has a premonition now. Although Ms. Jacob did not do much to lower her blood sugar ացավ gained a few pounds during the epidemic, her A1C also dropped to normal.

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