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Am Fam Physician. 2021;104(3):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 Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

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