People with prediabetes who are aged between 20 and 54 are more at risk of dying than older people, a new study has shown.
Prediabetes is when someone has raised blood sugar, but it is not high enough to be classed as diabetes.
Researchers at the University at Buffalo wanted to settle some of the conflicting arguments around prediabetes and mortality.
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First author assistant professor Obinna Ekwunife explained: “The literature has been inconsistent, particularly when accounting for key modifying factors, such as age, race/ethnicity and comorbidities.
“We wanted to explore whether these factors influenced the association between prediabetes and mortality in a nationally representative U.S. adult population.”
The team examined data on just over 38,000 people aged over 20, with 26.2% having prediabetes.
Individuals were classed as having prediabetes if their HbA1c (A1C) – their average blood glucose levels over a three-month period – was between 5.7% and 6.4%.
At the start, researchers found a significant link between prediabetes and mortality but once they controlled for factors such as demographics, lifestyle factors and comorbidities, this link disappeared.
However, in an important finding, the team found the significant relationship between prediabetes and mortality was maintained after adjustment when the analysis focused on those aged 20 to 54.
Assistant professor Ekwunife said that in older adults aged over 54, the impact of prediabetes might be overshadowed by existing comorbidities.
He said: “Another possibility is that prediabetes in younger adults might reflect a more detrimental disease trajectory with earlier onset of metabolic dysfunction.”
Other reasons for the link could be a stronger genetic predisposition which means the disease progresses with more speed. Health disparities could also be a factor for younger adults, including reduced access to care or less engagement with preventive care.
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Using virtual platforms, gamification or on-demand educational tools may appeal more to younger populations when it comes to tailoring diabetes prevention programmes, the authors say.
Assistant professor Ekwunife said: “We may need to be doing A1C screenings earlier in younger people. That would be particularly important for individuals with additional risk factors like obesity, a family history of diabetes, or socioeconomic disadvantages.
“Clinicians should recognise that early intervention could prevent both progression to diabetes and premature mortality and it gives patients an opportunity to make proactive lifestyle changes to prevent disease progression.”
Read more in JAMA Network Open
