creening for diabetes and prediabetes
Older adults are at high risk for both diabetes and prediabetes, with surveillance data suggesting that half of older adults have the latter (1). The ADA recommends that overweight adults with risk factors—and all adults aged ≥45 years—be screened in the clinical setting every 1–3 years using either an FPG test, A1C, or oral glucose tolerance test. The recommendations are based on substantial indirect evidence for the benefits of early treatment of type 2 diabetes, the fact that type 2 diabetes is typically present for years before clinical diagnosis, and the evidence that signs of complications are prevalent in “newly diagnosed” patients (17).
The benefits of identification of prediabetes and asymptomatic type 2 diabetes in older adults depend on whether primary or secondary preventive interventions would likely be effective and on the anticipated timeframe of the benefit of interventions versus the patient’s life expectancy. Most would agree that a functional and generally healthy 66-year-old individual should be offered diabetes screening since interventions to prevent type 2 diabetes or the complications of type 2 diabetes would likely be beneficial given the presumption of decades of remaining life. Most would also agree that finding prediabetes or early type 2 diabetes in a 95-year-old individual with advanced dementia would be unlikely to provide benefit.