Assessment of Screening Mammography Recommendations

Abstract

tant study that may revolutionize the way we define and manage prediabetes in older adults; however, several limitations should be noted.As the authors 1 remark, older adults are not a homogeneous population, and chronological age alone should not guide care. Perhaps owing to the paucity of quality data analyzing prediabetes and diabetes management among older adults, there is high potential for undertreatment and overtreatment in this population. 3 Frailty status has been demonstrated to have greater prognostic value than even the diagnosis or complications of prediabetes and diabetes. 2,4 While robust older adults might benefit from more aggressive prevention efforts, frail older adults may not tolerate standardof-care approaches derived from studies on fit patients. If variations in frailty status influenced the use of effective interventions, this could result in confounding by indication. Additionally, a new study 5 showed that the presence of factors such as moderate mobility impairment, or treatments for hypertension or hypercholesterolemia, modified the risk of older adults progressing from prediabetes to diabetes. In the authors' current study, 1 it may be the case that a subgroup of fit older adults with prediabetes was more likely to have received preventive lifestyle (eg, weight loss, exercise) or pharmacotherapeutic (eg, metformin, statin therapy) interventions, selectively influencing outcomes of progression to diabetes and possibly mortality. However, if the authors' results remain consistent controlling for this potential effect modification and/or confounding, it would strongly bolster the case to relax current screening and treatment of prediabetes in older adults.It is likely that many clinicians already incorporate some geriatric metrics into their clinical decisions, which might explain the deviations in treatment plans from past guidelines. 3 Physicians caring for patients with chronic illnesses must consider their cognition, ability to self-care, risk of polypharmacy, and resource availability. However, evidence is needed to ascertain which measures are the most prognostic in guiding management in older adults. We encourage the incorporation of such geriatric measures, encompassing frailty, in future studies of older adults to enhance the robustness of conclusions and recommendations.