[Skip to Navigation]
Invited Commentary
Less Is More
February 8, 2021

Prediabetes—A Risk Factor Twice Removed

Author Affiliations
  • 1Division of Geriatrics, Department of Medicine, University of California, San Francisco
  • 2Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California
JAMA Intern Med. 2021;181(4):520-521. doi:10.1001/jamainternmed.2020.8773

The concept of prediabetes (and similar concepts of impaired fasting glucose and impaired glucose tolerance) formally emerged in the 1990s to better characterize the incremental pathophysiology leading to the eventual development of diabetes.1 It is defined by ranges of disordered glucose values between normal and diabetes (eg, hemoglobin A1c levels, 5.7%-6.4% [to convert to the proportion of total hemoglobin, multiply by 0.01]). We treat it as a risk factor for diabetes; in midlife, those with a hemoglobin A1c level of 6.0% to 6.5% have 20 times the risk of developing diabetes compared with those with a hemoglobin A1c level of 5.0%.2

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    2 Comments for this article
    Thoughts about Prediabetes
    Michael Plunkett, MD MBA | Hospital

    I always practiced geriatric medicine and I liked it so much I became a geriatric patient myself. And I can tell you no mature person needs “pre anything.” For us the present sucks and we know that the future portends even worse. So show some respect for our elders, ask them what they want, and keep these half baked enthusiasms to yourself.
    Statins and glucose metabolism
    Paul Fader, M.D. |
    From previous studies using the Atherosclerosis Risk in Community cohort,  it appears that nearly 50% of the patients were on a statin. It is known that statins alter glucose metabolism although they decrease the risk of MI/CVA more in an at risk population than the relative risk increase for diabetes. In considering the diagnostic usefulness of prediabetes, was the baseline use of statins taken into account?