Prediabetes

the chance that you’ll need metformin later.”

Unfortunately, some doctors are prescribing medication to older adults with prediabetes, and many aren’t spending time discussing the implications of this condition with patients.

That was true for Elaine Hissam, 74, of Parkersburg, W.Va., who became alarmed last summer when she scored 5.8% on an A1C test. Hissam’s mother developed diabetes in adulthood, and Hissam dreaded the possibility that would happen to her too.

At the time, Hissam was going to exercise classes five days a week and walking 4 to 6 miles daily as well. When her doctor advised “watch what you eat,” Hissam cut out much of the sugar and carbohydrates in her diet and dropped 9 pounds. But when she had another A1C test at the start of this year, it had dropped only slightly, to 5.6%.

“My doctor really didn’t have much to say when I asked, ‘Why wasn’t there more of a change?’” Hissam said.

Experts I spoke with said fluctuations in test results are common, especially around the lower and upper ends of the prediabetes range. According to the CDC study, 2.8% of prediabetic seniors with A1C levels of 5.7% to 5.9% convert to diabetes each year.

Nancy Selvin, who learned last year that her A1C level had climbed to 6.3% from 5.9%, said she’s been trying to lose 6 pounds without success since getting those test results. Her doctor has told Selvin not to worry but prescribed a statin to reduce the potential for cardiovascular complications, since prediabetes is associated with an elevated risk of heart disease.

That conforms with one of the conclusions of the Johns Hopkins prediabetes study last year.

“Taken as a whole, the current evidence suggests that cardiovascular disease and mortality should be the focus of disease prevention among older adults rather than prediabetes progression,” the researchers wrote.

For her part, Libby Christianson, 63, of Sun City, Ariz., started walking more regularly and eating more protein after learning last summer that her A1C level was 5.7%.

“When my doctor said, ‘You’re prediabetic,’ I was shocked because I’ve always thought of myself as being a very healthy person,” she said.

“If prediabetes is a kick in the butt to move people to healthier behaviors, I’m fine with that,” said Dr. Kenneth Lam, a geriatrician at the University of California-San Francisco. “But if you’re older, certainly over age 75, and this is a new diagnosis, it’s not something I would worry about. I’m pretty sure that diabetes isn’t going to matter in your lifetime.”