Health

Elderly people with prediabetes should eat better, start moving, and stop fretting

According to the Centers for Disease Control and Prevention, almost half of the elderly (more than 26 million people over the age of 65) have prediabetes. How worried should they be?

Not so much, some experts say. They say that prediabetes (a term that refers to higher than normal but not extremely high blood sugar levels) is not a disease and does not necessarily mean that older people who have it will develop type 2 diabetes. increase.

“For most older patients, it’s not very likely that they will progress from prediabetes to diabetes,” said Dr. Robert Rush, Chief Health Officer of the Endocrine Society, commenting on a recent study. “Still labeling people with pre-diabetes may make them worried and worried.”

Other experts say it’s important to identify prediabetes, especially if older people are able to do more physical activity, lose weight, and eat a healthier diet to control their blood sugar levels. I think it is.

“The diagnosis of prediabetes should always be taken seriously,” said Elect, President of Medicine and Science at the American Diabetes Association, which recommends that adults over the age of 45 be screened for prediabetes at least once every three years. Dr. Rodica Busui said.

The CDC and the American Medical Association point out similar points in the ongoing “Do you have diabetes?” motion.

Still, many older people do not know what to do if they are told they have prediabetes. Nancy Selvin, 79, from Berkeley, California, is one of them.

A 5-foot, 106-pound potter, Selvin is slim and well-shaped. She takes one hour of rigorous exercise classes three times a week and eats a Mediterranean diet. Still, she has been worried since Selvin learned last year that her blood sugar was slightly higher than normal.

“I’m afraid of getting diabetes,” she said.

Two recent reports of prediabetes in the elderly have stimulated growing interest in this topic. Until they were published, most studies focused on prediabetes in middle-aged adults, and the importance of this condition in the elderly remained uncertain.

The latest study by CDC researchers, published at the JAMA Network Open in April, examined data on more than 50,000 prediabetic patients between January 2010 and December 2018. It was found that over 5% of these patients progress to diabetes each year.

Researchers used hemoglobin A1C, a measure of blood glucose over time. According to the Diabetes Association, prediabetes is indicated by A1C levels of 5.7% to 6.4%, or fasting blood glucose test values ​​of 100 to 125 milligrams per deciliter. (This glucose test assesses blood sugar levels after a person has eaten nothing for at least 8 hours.)

Notably, the results of the study show that obese elderly people with prediabetes are at significantly higher risk of developing diabetes. Elderly blacks, those with a family history of diabetes, low-income older people, and older people in the upper range of pre-A1C diabetes (6% to 6.4%) were also at risk. Men were slightly at higher risk than women.

The findings help providers personalize care for the elderly, Busui said.

They also confirm the importance of guiding older people with prediabetes, especially the most vulnerable, to lifestyle intervention programs, said Alain Koyama, lead author of the study and CDC epidemiologist. Stated.

Since 2018, Medicare has covered diabetes prevention programs. This is a series of classes offered by YMCA and other communities to help older people with prediabetes eat a healthier diet, lose weight and perform more physical activity. Studies show that prevention programs reduce the risk of diabetes in people over the age of 60 by 71%. However, only a small percentage of qualified people are registered.

Another study, published last year at JAMA Internal Medicine, will help us to look further into prediabetes. In 6.5 years, less than 12% of older people with prediabetes have been shown to have progressed to full-blown diabetes. In contrast, most died from other causes or returned to normal blood glucose levels during the study period.

Take out?

“It’s common for older people to have a slight increase in blood sugar, but this doesn’t mean the same as younger people. You don’t get diabetes, blindness, or lose. In Nancy Selvin’s daughter. Yes, said study co-author Elizabeth Selvin.

She is also a professor at Johns Hopkins Bloomberg School of Public Health.

“Few people develop the (diabetic) complications that we are really worried about young people,” she said.

Dr. Meda Munshi, Head of the Senile Diabetes Program at the Joslin Diabetes Center, an affiliate of Harvard Medical School, said: “But it is important to educate patients that this is not an inevitably diabetic and stressful illness.”

Many older people have slightly higher blood sugar levels due to lower insulin production and lower processing efficiency. It is included in the clinical diabetes guidelines, but not in the prediabetes guidelines, she said.

According to Dr. Victor Montri, an endocrinologist and professor of medicine at Mayo Clinic, aggressive treatment for prediabetes, such as metformin medication, should be avoided.

“When you have diabetes, you are prescribed metformin,” Montri said. “But it doesn’t make sense to administer metformin now because it may be at risk to reduce the likelihood that metformin will be needed later.”

Unfortunately, some doctors prescribe medications for older people with prediabetes, and many do not spend time discussing the effects of this condition with their patients.

This also applies to Elaine Hissam, 74, from Parkersburg, West Virginia. She was worried last summer when she scored 5.8% on her A1C test. Her mother of her Hissam developed diabetes in her adulthood, and Hissam was afraid that it could happen to her as well.

At that time, Hissam exercised five days a week in class and walked four to six miles every day. When her doctor advised, “See what you eat,” Hissam cut off much of the sugar and carbs in her diet and dropped nine pounds. But when she took another A1C test earlier this year, it dropped slightly to 5.6%.

“When I asked, my doctor didn’t really say much,” Why didn’t it change more? “Hissum said.

The experts I spoke with said that variability in test results was common, especially around the lower and upper limits of the prediabetes range. According to a CDC study, 2.8% of prediabetes elderly people with A1C levels of 5.7% to 5.9% turn to diabetes each year.

Nancy Selvin, who learned last year that her A1C level had risen from 5.9% to 6.3%, said she has been unsuccessfully trying to lose £ 6 since getting these test results. Her doctor told Selvin not to worry, but because prediabetes is associated with an increased risk of heart disease, she prescribed statins to reduce the likelihood of cardiovascular complications.

This is in line with one of the conclusions of last year’s Johns Hopkins Prediabetes Study.

“Overall, current evidence suggests that cardiovascular disease and mortality should be the focus of disease prevention in the elderly, not the progression of prediabetes,” the researchers write. I am.

On her side, Libby Christianson, 63, in Sun City, Arizona, started walking more regularly after learning that her A1C level was 5.7% last summer, and more protein. I started eating.

“When my doctor said,’You have prediabetes,’ I was shocked because I always thought I was a very healthy person,” she said.

Dr. Kenneth Lamb, a geriatrician at the University of California, San Francisco, said: “But if you’re older, certainly over 75, and this is a new diagnosis, that’s not something I’m worried about. I’m sure diabetes won’t be a problem in your lifetime. I am. “

Elderly people with prediabetes should eat better, start moving, and stop fretting

Source link Elderly people with prediabetes should eat better, start moving, and stop fretting

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