Abstract MP56: Progression of Hyperglycemia in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Introduction: Despite the high prevalence of prediabetes and diabetes in old age, the progression of hyperglycemia in older adults is not well-characterized. Objective: To characterize prevalence and predictors of hyperglycemia progression during 5 years of follow-up among 2894 older adults without diabetes (mean age 76, 60% female, 18% black). Methods: Using data from the ARIC Study, we report according to hyperglycemia (normal or prediabetes) status at baseline (visit 5, 2011-13) the incidence of visit 6 (2016-17) outcomes (normoglycemia, prediabetes, diabetes, or mortality). Multinomial logistic regression was used to identify predictors of these outcomes stratified by baseline hyperglycemia status. In a sensitivity analysis, we applied inverse probability of attrition weights (IPAW) to account for informative missingness. Results: Most participants (64%) with normal HbA1c at baseline had normal HbA1c at the follow-up visit, 19% progressed to prediabetes, 16% died, and 1% developed diabetes (HbA1c ≥6.5% or diabetes medication use or self-report diagnosis). Among participants with prediabetes at baseline, most remained prediabetic 5 years later (61%), 18% died, 14% reverted to normoglycemia, and 7% developed diabetes. Black participants, men, and those with hypercholesterolemia had a higher risk of hyperglycemia progression ( Table ). Physical activity was inversely associated with risk of progression. Body mass index (BMI) in older age was not associated with hyperglycemia progression and BMI was inversely associated with mortality. Results were similar when we used IPAW. Conclusions: In this community-based population of older adults, progression from prediabetes to diabetes was relatively uncommon over the 5 year period. Risk factors for hyperglycemia progression and mortality, such as BMI, may differ when measured in older adulthood. We also identified subgroups with higher risk of hyperglycemia progression in older age and who may benefit from targeted diabetes prevention efforts.