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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

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    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.
    CONFLICT OF INTEREST: None Reported
    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? 
    CONFLICT OF INTEREST: None Reported
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