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60% of adults at high risk for prediabetes according to risk assessment tool

The majority of adults in the United States aged 40 years and older are at high risk for prediabetes, according to research published in JAMA Internal Medicine.

A risk assessment tool found that 60% of adults aged 40 years and older and 80% of adults aged 60 years and older are at high risk for prediabetes, Saeid Shahraz, MD, PhD, from Tufts Medical Center, and colleagues reported.

"The Diabetes Prevention Program and other studies found that individuals with impaired glucose tolerance (based on a 75-g oral glucose tolerance test) can decrease their risk of type 2 diabetes developing either by an intensive supervised lifestyle intervention, including diet and exercise modification, or by metformin hydrochloride treatment," Shahraz and colleagues wrote. "Subsequently, the glycemic criteria for prediabetes were expanded to include hemoglobin A1c and a decreased level for fasting glucose."

They noted that prevention benefit is not certain, but the CDC, American Diabetes Association and the American Medical Association have endorsed a "web-based risk test to evaluate people at high risk for prediabetes for whom they recommend practice-based laboratory testing."

The researchers used data from the 2013-2014 National Health and Nutrition Examination Survey for 10,175 adults aged 18 years and older who did not have a type 2 diabetes diagnosis. They estimated risk scores by answering seven questions on each participant regarding age, sex, family history of diabetes, blood pressure history, physical activity and weight.

In participants aged 40 years and older (n = 3,815), Shahraz and colleagues calculated that 58.7% were at high risk for prediabetes (95% CI, 56-62). In participants aged 60 years and older (n = 1,841), they calculated that 80.8% were at high risk for prediabetes (95% CI, 78-84).

The researchers cautioned that the sweeping results may paint an incomplete picture.

"First, intensive lifestyle methods — even for those participants with impaired glucose tolerance — are most beneficial for those at the highest risk. Second, according to the US Preventive Services Task Force, there is no direct evidence that type 2 diabetes prevention alters the risk for diabetes-related complications," Shahraz and colleagues wrote. "Third, to our knowledge, the natural history of prediabetes based on the latest American Diabetes Association criteria has not been prospectively assessed, but it is likely that progression to type 2 diabetes will be slower with the expanded criteria compared with impaired glucose tolerance."

They concluded: "Finally, medicalization of prediabetes may have the unintended consequence of reducing health care access to patients with type 2 diabetes and other chronic conditions. A valid method to examine for prediabetes should avoid unnecessary medicalization by labeling a disease predecessor as a medical condition and seek to concentrate on people at highest risk to allow for efficient distribution of limited health care resources." – by Chelsea Frajerman Pardes

Disclosure: The authors report no relevant financial disclosures.