medwireNews: Prediabetes has no effect on the short-term mortality risk of older adults, suggests an analysis of the Atherosclerosis Risk in Communities (ARIC) study.
Neither was newly diagnosed diabetes a significant risk factor during a median 5.6 years of follow-up, whereas short-duration and long-standing diabetes raised the risk for all-cause mortality, and long-standing diabetes increased cardiovascular mortality risk.
“Our results are in contrast to studies in middle-aged adults that have demonstrated robust associations of prediabetes and undiagnosed diabetes with mortality,” write Elizabeth Selvin (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA) and co-researchers in Diabetes Care.
Of the 5791 people who were aged between 66 and 90 years (average 75.5 years) when they attended the fifth ARIC visit, 1737 had prediabetes, 251 had diabetes diagnosed at the visit or within the preceding year, 851 had short-duration diabetes (<10 years) and 852 had long-standing diabetes.
The rates of all-cause mortality per 1000 person–years were 21.2 for people without diabetes and 23.7 for those with prediabetes. There was no significant difference in mortality risk between these groups after accounting for factors including age, sex, education, vascular risk factors and medications, and prevalent cardiovascular disease (CVD).
Mortality rates per 1000 person–years increased to 33.8 and 29.6 among people with newly diagnosed and short-duration diabetes, respectively, but only the latter was significantly associated with mortality after accounting for confounders, at a 26% risk increase.
The mortality rate among people with long-standing diabetes was 48.6 per 1000 person–years, equating to a significant 71% adjusted risk increase relative to people without diabetes.
There was a similar pattern for CVD mortality, with rates increasing from 5.8 to 17.3 per 1000 person–years for people with no diabetes and long-standing diabetes, respectively, but only long-standing diabetes was significantly associated with CVD mortality after adjustment, at a 72% risk increase.
“Our results support current guidelines from the American Diabetes Association that recommend focusing on lifestyle modiﬁcation rather than initiation of pharmacologic intervention in older adults with prediabetes,” say Selvin and team.
They caution: “The risks of adverse effects of glucose-lowering medications–particularly hypoglycemia–and polypharmacy are heightened in older adults.”
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