Diagnosis of Diabetes in Older Adults

The article by Fang et al. (1) in the current issue of Diabetes Care investigates the implications of the recently published 2019 Endocrine Society guideline for the diagnosis of diabetes in older adults (2). It is well established that older people in the U.S. are at high risk for undiagnosed diabetes, which was confirmed by the current study. This is an important finding since these individuals are also at high risk for diabetic complications, both microvascular and macrovascular. These points were carefully addressed in the Endocrine Society guideline. The authors’ use of the term “standard diagnostic approach” as being limited to mean use of fasting plasma glucose (FPG) and HbA1c is a serious misinterpretation since the American Diabetes Association defines diabetes and prediabetes based on glucose measures including the 2-h post–glucose challenge glucose level (see Table 1 in the guideline [2]). Importantly, individuals with prediabetes are at increased risk for progression to diabetes and the development of cardiovascular disease (CVD). The FPG and HbA1c categories allow easy identification of both diabetes and prediabetes. However, many people over the age of 60 affected with diabetes and prediabetes are not diagnosed …