Perspectives on Prediabetes and Aging

It is undisputed that screening older adults for prediabetes, identifying individuals at a high risk of diabetes, and implementing healthy lifestyle interventions are effective in delaying and even preventing diabetes. Moreover, prediabetes carries its own risk of microvascular complications.61 However, the label "prediabetes" carries psychoso-cial and economic burdens that should be acknowledged. Implementing DPPs to target all older adults with prediabetes is becoming more challenging, particularly in parts of the world where prediabetes and diabetes are highly prevalent and resources are limited. Therefore, it is reasonable to allocate these valuable resources to sub-groups of older adults with prediabetes who are at higher risk of progression to dia-betes and most likely to benefit from preventive interventions.Moving forward, many questions related to prediabetes in older adults will need to be answered including: What is the optimal definition of prediabetes in older adults? How does the risk of progression from prediabetes to diabetes differ among subcat-egories of prediabetes (IFG vs IGT vs a slightly high A1C level)? Can we predict older adults with prediabetes who are more likely to progress to diabetes and diabetes -related comorbidities? Should diabetes prevention interventions be offered to all peo-ple with prediabetes or only to those at the highest risk of progression to diabetes? Until these questions are addressed, we will have to personalize our approach to cases of prediabetes in older adults and weigh the individual's healthy-life expectancy against the anticipated timeframe of any benefits (or risks) from diagnosing and man-aging prediabetes.