Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
Stockholm Gerontology Research Center, Stockholm, Sweden.
J Intern Med. 2019 Sep;286(3):326-340. doi: 10.1111/joim.12920. Epub 2019 Jun 4.
The natural history of prediabetes in older adults remains unknown.
To assess the rate at which prediabetes progresses to diabetes, leads to death or reverts to normoglycaemia in older adults and to identify prognostic factors related to different outcomes of prediabetes.
In the Swedish National Study on Aging and Care-Kungsholmen, 2575 diabetes-free participants aged ≥60 years were examined at baseline and followed for up to 12 years. At each wave, diabetes was diagnosed via medical examination, antidiabetic drug use, medical records or glycated haemoglobin (HbA1c) ≥6.5%. Prediabetes was defined as HbA1c ≥5.7% and normoglycaemia as HbA1c <5.7% in diabetes-free participants. Data were analysed with multinomial logistic regression.
At baseline, 918 (36%) individuals had prediabetes. Of them, 204 (22%) reverted to normoglycaemia (3.4/100 person-years, 95% CI 5.6-12.3), 119 (13%) developed diabetes (2.0/100 person-years, 95% CI 1.7-2.4) and 215 (23%) died (13.0/100 person-years, 95% CI 11.4-14.9) during the 12-year follow-up. The rates of reversion, progression and mortality were higher in the first 6-year than in the second 6-year follow-up, albeit not statistically significant. Lower systolic blood pressure (SBP), absence of heart diseases and weight loss promoted the reversion from prediabetes to normoglycaemia, whilst obesity accelerated its progression to diabetes.
During a 12-year follow-up, most of older adults with prediabetes remained stable or reverted to normoglycaemia, whereas only one-third developed diabetes or died. Lower SBP, no heart diseases and weight management may promote reversion to normoglycaemia, suggesting possible strategies for achieving normoglycaemia in older adults with prediabetes.
老年人糖尿病前期的自然史尚不清楚。
评估糖尿病前期进展为糖尿病、导致死亡或恢复为正常血糖的速度，并确定与糖尿病前期不同结局相关的预后因素。
在瑞典国家老龄化和关怀- Kungsholmen 研究中，对 2575 名年龄≥60 岁且无糖尿病的参与者进行了基线检查，并随访了 12 年。在每一个波次中，通过体检、使用抗糖尿病药物、医疗记录或糖化血红蛋白（HbA1c）≥6.5%来诊断糖尿病。无糖尿病的参与者中，HbA1c≥5.7%定义为糖尿病前期，HbA1c<5.7%定义为正常血糖。采用多项逻辑回归进行数据分析。
基线时，918 名（36%）个体患有糖尿病前期。其中，204 名（22%）恢复为正常血糖（3.4/100 人年，95%CI 5.6-12.3），119 名（13%）发展为糖尿病（2.0/100 人年，95%CI 1.7-2.4），215 名（23%）死亡（13.0/100 人年，95%CI 11.4-14.9）。在 12 年的随访期间，前 6 年的逆转、进展和死亡率均高于后 6 年，尽管无统计学意义。较低的收缩压（SBP）、无心脏病和体重减轻促进了糖尿病前期向正常血糖的逆转，而肥胖加速了其向糖尿病的进展。
在 12 年的随访期间，大多数患有糖尿病前期的老年人病情稳定或恢复为正常血糖，而只有三分之一的人发展为糖尿病或死亡。较低的 SBP、无心脏病和体重管理可能促进向正常血糖的逆转，这提示了在患有糖尿病前期的老年人中实现正常血糖的可能策略。
