Does Prediabetes Predict Diabetes Risk in Older Adults?

Prediabetes in community-dwelling older adults may not be an accurate indicator of diabetes risk, according to the results of a recent study. Death or regression to normoglycemia was a more likely outcome than developing diabetes in this patient population.

To examine this association, the researchers conducted a prospective cohort analysis that utilized data from the 2011-2013 Atherosclerosis Risk in Communities Study. Included were 3412 adults aged 71 to 90 years with prediabetes. Prediabetes was defined as a glycated hemoglobin (HbA1c) level of 5.7% to 6.4% and/or an impaired fasting glucose (IFG) level of 100-125 mg/dL. All participants were followed-up semiannually through 2017. Of the 3412, 2497 participants attended the follow-up visit or died before it occurred.

Overall, there were 156 cases of diabetes and 434 deaths within the 6.5-year follow-up period. Of the total participants, 44% (n = 1490) had HbA1c levels of 5.7% to 6.4%, 59% (n = 1996) had IFG, 73% (n = 2482) met the criteria for HbA1c or IFG, and 29% (n = 1004) met criteria for both HbA1c and IFG.

The results also indicated that:

  • In participants with HbA1c levels of 5.7% to 6.4% at baseline, 9% (n = 97) developed diabetes, 13% (n = 148) regressed to normoglycemia with HbA1c levels <5.7%, and 19% (n = 207) died.
  • In participants with IFG at baseline, 8% (n = 112) developed diabetes, 44% (n = 647) regressed to normoglycemia with FG <100 mg/dL, and 16% (n = 236) died.
  • In participants with HbA1c levels less than 5.7% at baseline, 17% (n = 239) increased to HbA1c levels of 5.7% to 6.4%, and 3% (n = 41) progressed to diabetes.
  • In participants with FG levels less than 100 mg/dL at baseline, 8% (n = 80) increased to IFG (FG, 100-125 mg/dL), and 3% (n = 26) progressed to diabetes.


“In this community-based cohort study of older adults, the prevalence of prediabetes was high; however, during the study period, regression to normoglycemia or death was more frequent than progression to diabetes. These findings suggest that prediabetes may not be a robust diagnostic entity in older age.”

—Leigh Precopio



Rooney MR, Rawlings AM, Pankow JS, et al. Risk of progression to diabetes among older adults with prediabetes. JAMA Intern Med. Published online February 8, 2021.