Abstract MP55: Glucose Abnormalities Detected by Continuous Glucose Monitoring in Older Adults With Prediabetes

Abstract

Introduction: The 2019 Endocrine Society guidelines recommend screening all older adults with prediabetes with a two-hour oral glucose tolerance test. Continuous glucose monitoring (CGM) is a minimally invasive technology that provides insights into glucose patterns and abnormalities not reflected in hemoglobin A1c (HbA1c). Objective: Characterize the prevalence of hyperglycemia and other abnormal glucose patterns in older adults with prediabetes. Methods: Participants in the Atherosclerosis Risk in Communities (ARIC) Study wore a CGM system at visit 9 (2021-2022). We evaluated CGM parameters according to diabetes status. Results: There were 944 participants (272 with diabetes, 342 with prediabetes, and 330 without diabetes) (mean age 83, 58% female, 25% Black). Compared to normoglycemic persons (HbA1c<5.7%), persons with prediabetes (HbA1c 5.7-<6.5%) had slightly higher mean glucose (103 vs 98 mg/dL, p<0.001), a higher percentage of people with mean glucose>140 mg/dL (1.5% vs 0%, p=0.03), spent more time with any hyperglycemia (median % time glucose >180 mg/dL: 0.23% vs 0.04%, p<0.001), spent similar time in range (86.6% vs 86.9%, p=0.68), and had similar glucose variability (CV 21.0% vs 20.8%, p=0.59) ( Table ). The mean amplitude of glycemic excursions, continuous overall net glycemic action and mean of daily differences were also higher in persons with prediabetes compared to normoglycemic persons but the differences are not clinically significant. Mean glucose and other CGM measures of hyperglycemia were substantially higher in persons with diabetes. Conclusion: CGM did not reveal a high prevalence of glucose abnormalities among older adults with prediabetes defined by HbA1c. Our findings do not support the current Endocrine Society guideline recommendations for additional post-load glucose testing in older adults with prediabetes.