How meaningful are prediabetes for older adults?

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    A few years ago, routine lab tests showed that 65-year-old clinical social worker Susan Glickman Weinberg’s hemoglobin A1C in Los Angeles was 5.8 percent, well above normal.

    “It’s supposed to be prediabetes,” her intern told her. A1C measures how much sugar is circulating in 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 manifestine.

    Recalling Ms. Weinberg “I felt that maybe I would get diabetes, I was very upset,” as he heard relatives talking about “this mysterious terrible thing” as a child.

    She Was already taking two blood pressure medications, a statin for cholesterol and an osteoporosis drug. Did he really need another prescription? She Worried, too, about the reported time of tainted imported drugs. She It was also not sure 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 this month in the journal Joma Internal Medicine, provides some answers to a very common condition known as prebiitis.

    Researchers found that over many years, older people, who were reportedly prediabetic, were more likely to have their blood sugar levels normalized than diabetes progressed. And he was less likely to die during the follow-up period than his peers with normal blood sugar.

    Elizabeth Selwyn, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore and senior author of the study, said, “Among the oldest adults, prebiotics probably shouldn’t be a priority.”

    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 typically 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.

    Diagnosis of prediabetes means you are more likely to develop diabetes, and “this drift leads to disease”, Drs. Said Kenneth Lam, a pediatrician at the University of California, San Francisco, and an author of the editorial with the 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.

    This fact has given rise to years of debate. Should older people with slightly above-normal blood sugar readings – a frequent occurrence since the pancreas produce less insulin in later life – take action, as urged by the American Diabetes Association?

    Or does labeling people already a normal part of “medical” aging, creating 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 suggest that a 2016 study showed that a popular online risk trial, conducted by the Centers for Disease Control and Prevention and the American Diabetes Association, called doihaveprediabetes.org, was used for prescribing everyone over 60. Will tell as

    In 2010, a CDC review reported that 9 to 25 percent of people with A1C of 5.5 to 6 percent would develop diabetes in five years; So there will be 25 to 50 percent of people 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 with elevated A1C levels and 44 percent of them with prediabetic fasting blood sugar – actually saw their readings return to normal blood sugar levels. (Swedish study found similar results.)

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

    “We don’t see much risk in these individuals,” Drs. Selwyn said. “Older adults may have complex health problems. Those who spoil the quality of life should concentrate, not lightly raise blood sugar. “

    The image
    Credit …Jenna Schoendendel for The New York Times

    A health researcher at Tufts Medical Center in Boston and the 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, a referral to lifestyle modification programs shown to reduce health risks and those who are obese and those under 60 Is probably metformin for.

    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 a third of the United States population, who insist on treating pre-diabetes, suggests that first-line treatment involves learning healthy behaviors that more Americans adopt anyway Should: 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.”

    Geriatricians 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 Li, co-author of the editorial with the new study at the University of California, San Francisco, and argues for a case-by-case approach in older adults, especially if the diagnosis of a prebiotic would cause their children to tie them on top of every cookie needed.

    Dr. Lam said that for a patient who is weak and weak, “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. She Diabetes can never progress; She may already follow recommended lifestyle modifications.

    Ms. Weinberg, now 69, sought help from a nutritionist, changed her diet to emphasize complex carbohydrates and protein, and began to walk more and climb stairs instead of taking a lift. She He didn’t need to lose to shed 10 pounds. In 18 months, he barely had a A1C reading height of 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. Jacobi, a retired fundus with a family history of diabetes, felt rheumatic. She Thought 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.

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