Should Older People Worry About Prediabetes? A Study Says Maybe Not

You’ve found out from a healthcare provider that you have prediabetes. This means that your blood glucose levels are higher than normal, but not high enough for a diabetes diagnosis.

Prediabetes is mostly considered a reversible precursor for diabetes. In older adults, however, it’s not common for prediabetes to progress to diabetes. What does this mean for you? Let’s take a closer look.

Should older adults get treatment for prediabetes?

Prediabetes is a common health condition. According to the Centers for Disease Control and Prevention, prediabetes affects:

• About one-third of the U.S. adult population

• Almost half of adults 65 years of age and over

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Not everyone with prediabetes will develop diabetes. Although the number of older adults living with prediabetes is high, progression to diabetes isn’t common in older adults. 

In fact, it’s common for high blood glucose levels to lower again or stay steady for the remainder of their lives. Although healthy lifestyle changes and medications can lower blood glucose levels and reverse prediabetes in younger people with the diagnosis, it may not be necessary for older individuals. 

Are higher than normal blood glucose levels bad for my health?

Having high blood glucose can harm a person’s health. Even with prediabetes, there’s an increased 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. Unless they get screened regularly, most people don’t know they have prediabetes, because there are usually no symptoms. 

In most people, a prediabetes diagnosis is an opportunity to take action and prevent getting type 2 diabetes. People with prediabetes will have their blood glucose levels checked regularly. A provider might recommend that they try healthy lifestyle changes or a medication called metformin. But is this necessary in older folks? There’s typically a slow progression from prediabetes to diabetes, so maybe not. 

What are the tests for prediabetes?

There are three blood tests to diagnose prediabetes: a fasting blood glucose test, an oral glucose tolerance test, and/or a hemoglobin A1C (HbA1C or A1C) test.

Prediabetes is diagnosed with one the following results:

• Fasting blood glucose of 100 mg/dl to 125 mg/dl

• Glucose tolerance of 140 mg/dl to 200 mg/dl 

• A1C of 5.7% to 6.4% 

Why did I get tested for prediabetes?

Healthcare providers test individuals that are at higher risk for developing prediabetes. 

You may have been tested for prediabetes because you’re a person who:

• Has obesity

• Is over age 45

• Has a parent or sibling with type 2 diabetes

• Had diabetes during pregnancy

• Exercises fewer than three times every week

• Is in a high-risk ethnicity group (African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and Asian Americans)

Choosing to treat prediabetes

Treating prediabetes is a choice. It’s important to know what your options are. Consider having a conversation with your healthcare provider and sharing your concerns, so you can make the right decision for you. 

Your individual health history is unique at every age, and the approach to treating prediabetes — or not — is up to you. 

What can I do to lower blood glucose levels?

Through sustained lifestyle changes you can:

• Increase daily activity levels and physical exercise

• Make improvements to your diet

• Set ideal weight goals

These changes can lower blood glucose levels and improve your body’s response to insulin. They really do make a difference. They may seem difficult at first, but they’ll be worth it in the long run.

Is there a medication to treat prediabetes?

Metformin is a medication that’s commonly used to treat prediabetes, although it is FDA-approved for only treatment of diabetes. It can help to restore blood sugars to normal levels. 

Metformin helps your body:

• Absorb less sugar from the foods you eat 

• Make less glucose 

• Use the insulin it makes more effectively

First-line treatment is usually lifestyle changes, such as diet and exercise. Although metformin is effective, it can have side effects. Consider learning more about metformin before taking it. 

What happens if prediabetes isn’t treated?

Prediabetes can lead to diabetes in some people. There’s a strong association between A1C levels and the development of diabetes. Depending on the A1C value, the risk is as high as 50% over 5 years. While the American Diabetes Association promotes physical activity as “the best medicine” for prediabetes, recent research suggests otherwise for older adults.

Research findings in older individuals (with a mean age of 75) show that it’s less common for prediabetes to turn into diabetes in this age group. Even without lifestyle changes or medications, blood glucose levels may not worsen in older adults — they may actually improve. They may also return to normal, or stay the same for the remainder of life. 

In middle-aged people with prediabetes, it’s a different story. Your risk of getting diabetes and related long-term health complications is increased.

Why trust our experts?

Written by:

Jewels Doskicz, RN, BA

Jewels Doskicz, RN, BA, is an Arizona-based registered nurse with 22 years of hospital-wide clinical nursing experience and 11 years of medical writing and editing experience. She was a former healthcare content creator for a digital health tool at HealthLoop and director of clinical content operations at GetWellNetwork.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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