A majority of older adults with prediabetes remain stable or revert to normoglycemia over the long term, typically as a result of lowering systolic blood pressure, avoiding heart disease, and managing weight, according to study results published in the Journal of Internal Medicine.
Researchers conducted this population-based longitudinal study to evaluate the rate at which older adults with prediabetes (hemoglobin A1c ≥5.7% to 6.4%) progress to diabetes, revert to normoglycemia, or die, and to pinpoint factors associated with each outcome. In total, 2575 Swedish individuals without diabetes at baseline (average age, 74.4) were evaluated at baseline and followed for up to 12 years, with assessments at 6 and, when possible, 12 years.
At baseline, 918 participants (36%) had prediabetes. In this group, 41% maintained prediabetes, 22% reverted to normoglycemia, 11% developed diabetes, and 23% died by the end of the 12-year follow-up. Although not statistically significant, the rates of reversion to normoglycemia, progression to diabetes, and mortality were higher at the 6-year than 12-year follow-up. Mortality rate was highest in participants 90 or older.
Controlling for follow-up time, demographic and lifestyle factors, heart disease, and other potential confounders, the researchers found that greater weight loss was significantly associated with increased odds of reversion to normoglycemia (odds ratio [OR], 2.0). This was especially true in participants who were overweight or obese at baseline (P =.03 and P =.06, respectively). There were also significant associations between reversion to normoglycemia and lower systolic blood pressure (OR, 0.9) and absence of heart diseases (OR, 0.5).
Several limitations were noted for this study, including an inability to differentiate prediabetes phenotypes.
In summarizing their findings the researchers said, “We found that baseline [body mass index], weight changes, [systolic blood pressure] and preexisting heart diseases could influence the natural history of prediabetes… [This finding] may help to identify people at high risk of progressing to diabetes and suggests possible strategies for achieving normoglycemia in older adults with prediabetes.”
Shang Y, Marseglia A, Fratiglioni L, et al. Natural history of prediabetes in older adults from a population-based longitudinal study [published online June 4, 2019]. J Intern Med. doi:10.1111/joim.12920