The prevalence of prediabetes and diabetes increases substantially with age. In the U.S., an estimated 25% of adults 65 years or older have diabetes, whereas more than 50% meet criteria for prediabetes depending on the definition used. Despite the high prevalence of diabetes and prediabetes among older adults, progression of hyperglycemia over time (the transition from normoglycemia to prediabetes or diabetes or transition from prediabetes to diabetes) is poorly characterized in this population.

The American Diabetes Association (ADA) has highlighted the prognostic implications of hyperglycemia among older adults as a critical knowledge gap and says the natural history of prediabetes in older adults in inadequately understood. There are several definitions for prediabetes used in current clinical practice and no consensus on which definition is optimal. Depending on the definition, the prevalence of prediabetes in our study ranged from 29% to 73%.

The ADA guidelines recommend annual diabetes screening for adults who meet the criteria for prediabetes. In 2019, the Endocrine Society recommended that older adults with prediabetes defined by a HbgA1c and/or fasting glucose be further screened using a 2-hour oral glucose tolerance test to avoid under-diagnosis of diabetes. A previous study found that this strategy is likely to have little clinical and public health benefit because treatment would not change for older adults identified as having diabetes. Be sure your physicians are reviewing all lab values timely! Educate your licensed staff on the meaning of each lab value so that in the event an abnormal result is received, they understand the implications of not doing something about it!

Stay the course, stay well, mask up, get vaccinated, and stay tuned!