Patient-Oriented Evidence That Matters

The Risk of Progression from Prediabetes to Diabetes in Older Adults Is Low


Am Fam Physician. 2021 Sep ;104(2):online.

Clinical Question

What is the likelihood that older adults with pre-diabetes will develop diabetes mellitus over an average of 6.5 years?

Bottom Line

Older patients generally will not progress to diabetes; they will either, over an average of 6.5 years, stay at the prediabetic levels or revert to normal levels. If a patient makes it to their mid-70s without a diagnosis of diabetes, it is unlikely to occur. (Level of Evidence = 1b−)


Prediabetes has a few definitions. This study evaluated 3,412 community-dwelling participants, including 2,482 patients who had an A1C level of 5.7% to 6.4% (n = 1,490) or a fasting glucose level of 100 mg per dL (5.55 mmol per L) to 125 mg per dL (6.94 mmol per L; n = 1,996), or both, in a community cohort of adults with a mean age of 75.5 years. Over 6.5 years of follow-up with 27% attrition, 9% of patients with elevated A1C levels progressed to diabetes and 13% regressed to normoglycemia. Of those with elevated fasting glucose levels, 8% developed diabetes and 44% returned to normoglycemia. These rates compare with a 3% development of diabetes in patients with normoglycemia at the start.

Study design: Randomized controlled trial (single-blinded)

Funding source: Industry and government

Setting: Emergency department

Reference: Rooney MR, Rawlings AM, Pankow JS, et al. Risk of progression to diabetes among older adults with prediabetes [published correction appears in JAMA Intern Med. 2021;181(4):570]. JAMA Intern Med. 2021;181(4):511–519.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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