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How Meaning Is Prediabetes For the Elderly?

A few years ago, in regular lab tests, Susang Rickman Weinberg, then a 65-year-old clinical social worker in Los Angeles, had a hemoglobin A1C value of 5.8%, slightly above normal.

“This is considered pre-diabetes,” her physician told her. A1C measures the amount of sugar circulating in the bloodstream over time. If her result reaches 6% (still below the 6.5 that defines diabetes), her doctor said she would recommend the widely prescribed drug metformin.

“The idea that I might get diabetes was very frustrating,” recalled Weinberg when he heard his relatives say “this mysterious terrible thing” as a kid.

She was already taking two blood pressure medications, a cholesterol statin and an osteoporosis medication. Did she really need another prescription? She was also worried about reports of contaminated imported drugs. She didn’t even know what prediabetes meant or how quickly it became diabetic.

“I felt like zero patients,” she said. “There were a lot of unknowns.”

Currently, the number of unknowns is decreasing. Longitudinal study of the elderlyHere are some answers about a very common intermediate state known as prediabetes, published online this month in the journal JAMA Internal Medicine.

Over the years, researchers have found that older people who appear to have prediabetes are far more likely to return to normal blood sugar levels than to progress to diabetes. And they were less likely to die during the follow-up period than their peers with normal blood sugar levels.

“For most older people, prediabetes should not be a priority,” said Elizabeth Selvin, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore and the lead author of the study.

Prediabetes, a condition rarely discussed until 15 years ago, means that blood sugar levels are higher than normal but do not exceed the threshold for diabetes. This is usually defined by a hemoglobin A1C reading of 5.7 to 6.4 percent, or a fasting blood glucose level of 100 to 125 mg / dL. In middle age, it can be a precursor to serious health problems.

Diagnosis of pre-diabetes means that you are more likely to develop diabetes, “which leads to downstream illness,” said Dr. Kenneth Lam, an old doctor and author at the University of California, San Francisco. .. Editorial with research.. “It damages your kidneys, your eyes and your nerves. It causes a heart attack and a stroke,” he said.

But for older people who are trying to raise their blood sugar, the story is different. These horrific consequences take years to develop, and many in the 70’s and 80’s can’t live long enough to encounter them.

That fact was generated Many years of discussion.. As the American Diabetes Association argues, do older people with slightly higher than normal blood sugar levels (which occur more often because the pancreas produces less insulin in later years) need to take action?

Or does labeling people with prediabetes simply “medicalize” the normal part of aging and cause unnecessary anxiety for people who are already dealing with multiple health problems?

Dr. Selvin and her colleagues analyzed the results of an ongoing national survey on cardiovascular risk that began in the 1980s. When 3,412 participants came to physical and clinical examinations between 2011 and 2013, they reached the age of 71-90 and were not diabetic.

However, prediabetes was widespread. Almost three-quarters have been identified as prediabetes based on either A1C or fasting blood glucose levels.

These findings are reflected 2016 survey A popular online risk test created by the Centers for Disease Control and Prevention and the American Diabetes Association, Almost everyone over the age of 60 is considered prediabetes.

In 2010, CDC review reported 9-25% of people with A1C of 5.5-6% develop diabetes in 5 years. So are 25 to 50 percent of people with A1C measurements of 6 to 6.5. However, those estimates were based on the middle-aged population.

When Dr. Selvin and her team looked at what really happened to their older prediabetes cohort five to six years later, only 8 or 9 percent developed diabetes, depending on the definition used. did.

A much larger group (13% of the group with elevated A1C levels and 44% of the group with prediabetes fasting blood glucose) actually saw the measurements return to normal blood glucose. (((Swedish study Similar results were found. )

16-19% die, about the same as those without prediabetes.

“These individuals are less at risk,” said Dr. Selvin. “Elderly people can have complex health problems. We should focus on what impairs our quality of life, not on mild increases in blood sugar.”

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

That may be the case with Dr. Robert Gavey, ADA’s Chief Scientific and Medical Officer. The organization currently recommends “at least annual monitoring” for pre-diabetic patients. Lifestyle fix It has been shown to reduce health risk and possibly metformin in people under the age of 60 with obesity.

Now, the Association’s Expert Practice Committee has reviewed the study and “it can bring some adjustments to the way we think about things,” said Dr. Gabbay. “Their risk may be less than we thought,” he added, among older people who are considered pre-diabetes.

Advocates focused on treating prediabetes, which is said to afflict one-third of the U.S. population, said that first-line treatment includes weight loss, quitting, exercise, and a healthy diet. It points out that it involves learning healthy behaviors that Americans should adopt anyway.

“I have been diagnosed with prediabetes in many patients, and that motivates them to change,” said Dr. Gabbay. “They know what they should do, but they need something to prepare them.”

Geriatricians tend to oppose it. “It’s not an expert to mislead people and motivate them for fear of not being true,” said Dr. Lam. “We are all tired of being afraid.”

He and Dr. Sei Lee, a co-author of an editorial accompanying the new study and a geriatric scholar at the University of California, San Francisco, discuss a case-by-case approach in the elderly, especially if the diagnosis of prediabetes is the cause. To do. Their children offend them with all the cookies.

For frail and vulnerable patients, “it is likely that they are dealing with many other problems,” Dr. Lam said. “Don’t worry about this number.”

A very healthy 75-year-old who can live for more than 20 years faces more subtle decisions. She may never progress to diabetes. She may also have already followed the recommended lifestyle changes.

Weinberg, now 69, turned to a nutritionist to change his diet to emphasize complex carbs and proteins, walk more instead of taking the elevator, and start climbing stairs. She shed £ 10 she didn’t have to lose. For over 18 months, her barely elevated A1C readings dropped to 5.6.

Her friend Carol Jacobian, 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-diabetes, but her physician immediately prescribed metformin.

Jacobian, a retired fundraiser with no family history of diabetes, was indifferent. She thought she could lose some weight, but she had normal blood pressure and a lively life that included a lot of walking and yoga. After trying the drug for a few months, she quit.

Currently, neither woman has prediabetes. Jacobian did nothing to lower her blood sugar and gained a few pounds during the pandemic, but her A1C also fell to normal levels.

How Meaning Is Prediabetes For the Elderly?

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