Key takeaways:
While prediabetes can lead to diabetes, the outcome isn’t the same for everyone.
In older adults, it’s less common for prediabetes to turn into diabetes, according to recent research.
Lifestyle changes, including more physical activity and lower sugar intake, can help prevent the progression from prediabetes to diabetes.
Prediabetes is a common condition in the U.S. And it gets more common as you get older — almost half of people in the U.S. over the age of 65 have the condition. And while prediabetes can be a precursor for Type 2 diabetes, the risk isn’t the same for everyone. In older adults, it’s not as common for prediabetes to progress to diabetes.
No matter your age, prediabetes is reversible with the right treatment approach. So what does this mean for older adults with prediabetes? Let’s take a closer look.
Should older adults get treatment for prediabetes?
Not necessarily. While prediabetes is a risk factor for developing Type 2 diabetes, it doesn’t always progress that way. This is especially true for older adults.
Experts recommend lifestyle changes and sometimes medication for people with prediabetes. For older adults, a more moderate treatment approach may be appropriate. That’s because high blood glucose levels may lower again or stay steady for years. Medication can lower blood glucose levels and reverse prediabetes in younger people with the diagnosis, but it’s often not necessary for older individuals.
At any age, it’s important to keep blood sugar within a normal range to prevent long- and short-term health complications. But in older people with prediabetes, their blood sugar is less likely to cause serious short-term risks. And the long-term complications of high blood sugar take years to develop. So it may not be necessary to treat prediabetes in an older person who isn’t facing the possibility of decades of diabetes-related damage.
Treating prediabetes is a choice, and it’s important to know what your options are. If you have prediabetes, your primary care provider can discuss them with you. But the approach to treating prediabetes — or not — is up to you.
How concerned should older adults be about prediabetes?
Research suggests that prediabetes in older adults is unlikely to progress to diabetes. Even without lifestyle changes or medications, high blood sugar levels may not worsen in this age group — they may actually return to normal or stay the same.
One study followed individuals (average age of 75 years) with prediabetes for over 6 years. In the end, a higher percentage of people had glucose levels return to normal (13%) than those who progressed to diabetes (9%).
Another study showed a similar risk of progression to diabetes in older people. Overall, about 5% of people 65 years and older with prediabetes progressed to diabetes each year. Diabetes was more likely in Black people and in those with:
Body mass index (BMI) of over 40
Hemoglobin A1C greater than 6% (compared with 5.7%-5.9%)
Family history of diabetes
Understanding prediabetes: This guide to prediabetes explains the signs, screening, diagnosis, and treatment for the condition.
Reversing prediabetes: Learn about lifestyle changes that can help reverse prediabetes and lower the risk of Type 2 diabetes.
Eating with prediabetes: There’s not a specific diet for prediabetes, but making certain changes can go a long way in managing your blood sugar.
Are higher than normal blood glucose levels bad for my health?
Yes. Having high blood glucose can increase the risk for heart disease and stroke. If blood glucose levels continue to increase into the range associated with Type 2 diabetes, the risk of other complications increases, too.
A prediabetes diagnosis is an opportunity to take action and prevent getting Type 2 diabetes. First, if you have prediabetes, you’ll have your blood glucose levels checked regularly. A healthcare professional will likely recommend trying healthy lifestyle changes (more below) and/or a medication called metformin. But is medication necessary in older adults? According to the latest research, maybe not.
How can older adults prevent or manage prediabetes?
Lifestyle changes are the best way to prevent the development of Type 2 diabetes. These changes can lower blood sugar levels and improve your body’s response to insulin.
Any lifestyle or behavioral change can be hard at first. But not only will they help you manage prediabetes, you may start to notice other health benefits, too.
And help is available. Part B of Medicare covers the Diabetes Prevention Program. This means you can get guidance on diet and exercise from trained coaches, as well as support from your peers, for free. Studies show this program helps prevent Type 2 diabetes by up to 58% in older adults. Find a program near you.
Exercise
There are so many health benefits of moving your body regularly. It can improve blood sugar, muscle mass, cardiovascular risk, and bone strength. And it doesn’t have to be complicated. Good examples of exercise include walking, swimming, and tai chi. There is no “best” exercise — go with whatever you enjoy and can do consistently.
The exercise goal for most adults is moderate-intensity physical activity at least 150 minutes per week. And if you’re new to exercise, check in with a healthcare professional first and start slowly to avoid injury.
Diet improvements
Improving your diet is really important for managing blood sugar. It can also help other heart disease risk factors like blood pressure and cholesterol. It’s best to follow a meal plan that reduces sugar and includes more whole foods like fish, fruits, and veggies.
Weight management
This won’t look the same for everyone. Weight loss can help manage some of the health issues discussed here, but it may not be appropriate for all older adults.
When in doubt, it’s best to discuss your weight goals with a healthcare professional. They can help get you on the right track safely with science-backed tips. Keep in mind that fad diets are not safe and do more harm than good.
Smoking cessation
Smoking increases your risk of Type 2 diabetes and heart disease, among other conditions. Quitting smoking is hard, to say the least, so be sure to get help if you’re trying to quit.
Frequently asked questions
Prediabetes commonly responds to lifestyle changes, so it doesn’t always require medication. Diabetes medications like metformin and glucagon-like peptide-1 (GLP-1) agonists (Ozempic) are sometimes used to treat prediabetes. But they are FDA approved for treatment of diabetes — not prediabetes — so some experts actually recommend against them. Keep in mind there are risks with any medication, so it’s important to weigh the risks against benefits before starting.
There are three blood tests to diagnose prediabetes: fasting blood glucose, glucose tolerance, and hemoglobin A1C. Because A1C isn’t always accurate in older people with other medical conditions, the glucose tolerance test may be more reliable.
Prediabetes can lead to diabetes in some people. There’s a strong association between A1C levels and the development of diabetes. The higher someone’s A1C value, the more likely they are to develop diabetes. This risk seems to start increasing with values above 5. But as noted above, the risk doesn’t seem to be as high for older adults.
Risk factors for prediabetes are similar to those of Type 2 diabetes. They include:
Excess weight
Being over age 45 years
Having a parent or sibling with Type 2 diabetes
History of diabetes during pregnancy
Exercising fewer than three times every week
Being African American, Hispanic/Latino, American Indian, Pacific Islander, and/or Asian American
Prediabetes commonly responds to lifestyle changes, so it doesn’t always require medication. Diabetes medications like metformin and glucagon-like peptide-1 (GLP-1) agonists (Ozempic) are sometimes used to treat prediabetes. But they are FDA approved for treatment of diabetes — not prediabetes — so some experts actually recommend against them. Keep in mind there are risks with any medication, so it’s important to weigh the risks against benefits before starting.
There are three blood tests to diagnose prediabetes: fasting blood glucose, glucose tolerance, and hemoglobin A1C. Because A1C isn’t always accurate in older people with other medical conditions, the glucose tolerance test may be more reliable.
Prediabetes can lead to diabetes in some people. There’s a strong association between A1C levels and the development of diabetes. The higher someone’s A1C value, the more likely they are to develop diabetes. This risk seems to start increasing with values above 5. But as noted above, the risk doesn’t seem to be as high for older adults.
Risk factors for prediabetes are similar to those of Type 2 diabetes. They include:
Excess weight
Being over age 45 years
Having a parent or sibling with Type 2 diabetes
History of diabetes during pregnancy
Exercising fewer than three times every week
Being African American, Hispanic/Latino, American Indian, Pacific Islander, and/or Asian American
The bottom line
Prediabetes is a manageable condition. If you have it, that doesn’t mean that you’ll develop diabetes, especially if you’re an older adult. Lifestyle changes, like getting more physical activity and modifying eating habits, is the best course of action for prediabetes in this age group. But everyone is different, so it’s important to discuss your risk factors with a healthcare professional.
Why trust our experts?
References
American Diabetes Association. (n.d.). Understanding diabetes diagnosis.
American Diabetes Association. (2019). 3. Prevention or delay of type 2 diabetes: Standards of medical care in diabetes—2020. Diabetes Care.
Bardenheier, B. H., et al. (2021). Progression to diabetes by baseline glycemic status among middle-aged and older adults in the United States, 2006–2014. Diabetes Research and Clinical Practice.
Centers for Disease Control and Prevention. (2024). National Diabetes Statistics Report.
Centers for Disease Control and Prevention. (2024). Older adults: Adding activity recommendations.
Centers for Disease Control and Prevention. (2024). Prediabetes — your chance to prevent type 2 diabetes.
Koyama, A. K., et al. (2022). Progression to diabetes among older adults with hemoglobin A1c–defined prediabetes in the US. JAMA Network Open.
LeRoith, D., et al. (2019). Treatment of diabetes in older adults: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism.
Medicare.gov. (n.d.). Medicare Diabetes Prevention Program.
Rooney, M. R., et al. (2021). Risk of progression to diabetes among older adults with prediabetes. JAMA Internal Medicine.
Zhang, X., et al. (2010). A1C level and future risk of diabetes: A systematic review. Diabetes Care.
