Association of prediabetes with death and diabetic complications in older adults: the pros and cons of active screening for prediabetes

Abstract

Background active screening can improve health outcomes for people with prediabetes. However, its efficacy in older adults remains uncertain. Objective the study aimed to analyse the progression from prediabetes to diabetes in older adults, including associated complications and mortality rates, to determine the benefits of active screening. Design retrospective cohort study. Setting Korean National Health Insurance Service claims database. Subjects a total of 36,946 adults aged ≥65 years who underwent national health examinations from 2006 to 2008. Methods follow-up was until 31 December 2015. Cox’s proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for death and diabetic complications. Results over a median follow-up of 8.2 years, 19.3% of older adults with prediabetes progressed to diabetes. Compared with normoglycaemic adults, the multivariable-adjusted HRs (95% CI) for major adverse cardiovascular events were 1.01 (0.95–1.07), 1.08 (0.95–1.23), 1.14 (1.05–1.23) and 1.50 (1.35–1.68) in adults with prediabetes, newly diagnosed diabetes, diabetes not on insulin and diabetes on insulin, respectively. The corresponding HRs (95% CI) for diabetic retinopathy risk were 1.28 (1.15–1.43), 3.16 (2.71–3.69), 6.58 (6.02–7.19) and 9.17 (8.21–10.24). Diabetic nephropathy risk also significantly increased. Conclusions progression from prediabetes to diabetes is an important concern among older adults. Prediabetes is associated with the risk of microvascular complications, but not cardiovascular complications and mortality. Therefore, active regular screening for prediabetes is necessary to prevent microvascular complications.

Risk of Cause-Specific Mortality across Glucose Spectrum in Elderly People: A Nationwide Population-Based Cohort Study

“…Our data provide valuable insights for health administrators regarding public resource allocation. We found that the risk of mortality was consistently increased in the IFG group, with a HR of 1.06 and 95% CI of 1.05 to 1.07, which aligns with a recent report [ 22 ]. Approximately 50% of the elderly population falls under the IFG category [ 2 ].…”

Diabetes screening in South Korea: a new estimate of the number needed to screen to detect diabetes

“…In South Korea, almost 20% of adults aged ≥ 65 years with prediabetes progress to diabetes. In addition, in adults aged ≥ 75 years diagnosed with prediabetes or diabetes, the risk of diabetic complications did not increase [ 33 ]. However, in the current study, we included all adults aged ≥ 20 years, including older adults, to evaluate the effectiveness of screening for diabetes.…”

Cardiovascular and microvascular outcomes according to vitamin D level and genetic variants among individuals with prediabetes: a prospective study

“…Prediabetes is a growing public concern leading to serious vascular consequences [ 1 , 2 ]. It was estimated that prediabetes affects 470 million people worldwide by 2030, who would suffer from end-organ damages in heart, brain, kidney, and eye before the diagnosis of diabetes [ 3 , 4 ].…”

“…However, traditional lifestyle and drug-based interventions did no significantly reduce the risk of vascular complications among prediabetic individuals, such as myocardial infarction and stroke [ 5 ]. Development of new strategy to prevent vascular complications are urgently needed for people with prediabetes [ 2 ].…”