Almost half of older adults — more than 26 million people 65 and older — have prediabetes, according to the Centers for Disease Control and Prevention. How concerned should they be?

Not very, say some experts. Prediabetes — a term that refers to above-normal but not extremely high blood sugar levels — isn’t a disease, and it doesn’t imply that older adults who have it will inevitably develop Type 2 diabetes, they note.

“For most older patients, the chance of progressing from prediabetes to diabetes is not that high,” said Dr. Robert Lash, chief medical officer of the Endocrine Society, commenting on recent research. “Yet labeling people with prediabetes may make them worried and anxious.”

Other experts believe it’s important to identify prediabetes, especially if this inspires older adults to get more physical activity, lose weight, and eat healthier diets to help bring blood sugar under control.

“Always a diagnosis of prediabetes should be taken seriously,” said Dr. Rodica Busui, president-elect of medicine and science at the American Diabetes Association, which recommends adults 45 and older get screened for prediabetes at least once every three years. The CDC and the American Medical Association make a similar point in their ongoing “Do I Have Diabetes?” campaign.

According to the American Diabetes Association, an estimated 84 million Americans age 20 and older have pre-diabetes.

Still, many older adults aren’t sure what they should be doing if they’re told they have prediabetes. Nancy Selvin, 79, of Berkeley, California, is among them.

At 5 feet and 106 pounds, Selvin, a ceramic artist, is slim and in good physical shape. She takes a rigorous hour-long exercise class three times a week and eats a Mediterranean-style diet. Yet Selvin has felt alarmed since learning last year her blood sugar was slightly above normal.

“I’m terrified of being diabetic,” she said.

Two recent reports about prediabetes in the older population are stimulating heightened interest in this topic. Until their publication, most studies focused on prediabetes in middle-aged adults, leaving the significance of this condition in older adults uncertain.

The newest study by researchers at the CDC, published in April in JAMA Network Open, examined data about more than 50,000 older patients with prediabetes between January 2010 and December 2018. Just over 5% of these patients progressed to diabetes annually, it found.

Researchers used a measure of blood sugar levels over time, hemoglobin A1C. Prediabetes is signified by A1C levels of 5.7% to 6.4% or a fasting plasma glucose test reading of 100 to 125 milligrams per deciliter, according to the diabetes association. (This glucose test evaluates blood sugar after a person hasn’t eaten anything for at least eight hours.)

Higher risks for some groups

Of note, study results show that obese older adults with prediabetes were at significantly heightened risk of developing diabetes. Also at risk were Black seniors, those with a family history of diabetes, low-income seniors, and older adults at the upper end (6%-6.4%) of the A1C prediabetes range. Men were at slightly higher risk than women.

The findings can help providers personalize care for older adults, Busui said.

They also confirm the importance of directing older people with prediabetes — especially those who are most vulnerable — to lifestyle intervention programs, said Alain Koyama, the study’s lead author and an epidemiologist at the CDC.

Since 2018, Medicare has covered the Diabetes Prevention Program, a set of classes offered at YMCAs and in other community settings designed to help seniors with prediabetes eat healthier diets, lose weight, and get more physical activity. Research has shown the prevention program lowers the risk of diabetes by 71% in people 60 and older. But only a small fraction of people eligible have enrolled.

Another study, published in JAMA Internal Medicine last year, helps put prediabetes in further perspective. Over the course of 6.5 years, it showed, fewer than 12% of seniors with prediabetes progressed to full-fledged diabetes. By contrast, a larger portion either died of other causes or shifted back to normal blood sugar levels over the study period.

The takeaway? “We know that it’s common in older adults to have mildly elevated glucose levels, but this doesn’t have the same meaning that it would in younger individuals — it doesn’t mean you’re going to get diabetes, go blind, or lose your leg,” said Elizabeth Selvin, daughter of Nancy Selvin and a co-author of the study. She is also a professor at Johns Hopkins Bloomberg School of Public Health.

“Almost no one develops the [diabetes] complications we’re really worried about in younger people.”

“It’s OK to tell older adults with prediabetes to exercise more and eat carbohydrates evenly throughout the day,” said Dr. Medha Munshi, director of the geriatric diabetes program at Joslin Diabetes Center, an affiliate of the Harvard Medical School. “But it’s important to educate patients that this is not a disease that is inevitably going to make you diabetic and stress you out.”

Many older people have slightly elevated blood sugar because they produce less insulin and process it less efficiently. While this is factored into clinical diabetes guidelines, it hasn’t been incorporated in prediabetes guidelines, she noted.

Drugs not recommended for prediabetes

Aggressive treatments for prediabetes, such as the medication metformin, should be avoided, according to Dr. Victor Montori, an endocrinologist and professor of medicine at the Mayo Clinic. “If you get diabetes, you will be prescribed metformin. But it’s just nonsense to give you metformin now, because you may be at risk, to reduce the chance that you’ll need metformin later.”

Unfortunately, some doctors are prescribing medication to older adults with prediabetes, and many aren’t spending time discussing the implications of this condition with patients.

That was true for Elaine Hissam, 74, of Parkersburg, West Virginia, who became alarmed last summer when she scored 5.8% on an A1C test. Hissam’s mother developed diabetes in adulthood, and Hissam dreaded the possibility that would happen to her too.

At the time, Hissam was going to exercise classes five days a week and walking 4 to 6 miles daily as well. When her doctor advised “watch what you eat,” Hissam cut out much of the sugar and carbohydrates in her diet and dropped 9 pounds. But when she had another A1C test at the start of this year, it had dropped only slightly, to 5.6%.

“My doctor really didn’t have much to say when I asked, ‘Why wasn’t there more of a change?’” Hissam said.

Experts I spoke with said fluctuations in test results are common, especially around the lower and upper ends of the prediabetes range. According to the CDC study, 2.8% of prediabetic seniors with A1C levels of 5.7% to 5.9% convert to diabetes each year.

Focus on cardiovascular risks

Nancy Selvin, who learned last year that her A1C level had climbed to 6.3% from 5.9%, said she’s been trying to lose 6 pounds without success since getting those test results. Her doctor has told Selvin not to worry but prescribed a statin to reduce the potential for cardiovascular complications, since prediabetes is associated with an elevated risk of heart disease.

That conforms with one of the conclusions of the Johns Hopkins prediabetes study last year. “Taken as a whole, the current evidence suggests that cardiovascular disease and mortality should be the focus of disease prevention among older adults rather than prediabetes progression,” the researchers wrote.

For her part, Libby Christianson, 63, of Sun City, Arizona, started walking more regularly and eating more protein after learning last summer that her A1C level was 5.7%. “When my doctor said, ‘You’re prediabetic,’ I was shocked because I’ve always thought of myself as being a very healthy person,” she said.

“If prediabetes is a kick in the butt to move people to healthier behaviors, I’m fine with that,” said Dr. Kenneth Lam, a geriatrician at the University of California-San Francisco. “But if you’re older, certainly over age 75, and this is a new diagnosis, it’s not something I would worry about. I’m pretty sure that diabetes isn’t going to matter in your lifetime.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism.

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Dean Short made a career out of transporting Tucsonans out of the desert, by bringing elsewhere to us. Props have been central to the game: a neon gas lamp, larger than life, outside of Ye Olde Lantern steakhouse; a steer statue on the roof of Cow Town in Amado; the Wild West movie set appeal of El Corral. Nowhere, though, were the props more extravagant, or more central, than Kon Tiki.

The windowless bar is dressed from floor to ceiling like a Polynesian outpost that exists more in the American historical imagination than in Tahiti. The tropical kitsch conjures a place totally unlike Tucson: a water fountain homed in a giant clam, lamps like enormous marbles hanging from the ceiling in fishing nets, dining room separators made of stacked coconuts.

Live animals have been used. What is now used as a patio was once an aviary of parrots. All of the tropical fish in their tank were born in it: the colony has been self-sustaining for decades.

The rum-forward menu was taken from its forbears like Trader Vic’s: almond-tinged mai tais, technicolor blue Hawaiis, potent zombies, fruity pain killers and their specialty, the scorpion bowl.

A “Pain Killer” at Kon Tiki contains Zaya Caribbean rum, Nephew overproof rum, a coconut milk base, and a dash of elderflower.

Grace Trejo, Arizona Daily Star

“A single scorpion is four shots of liquor with elixirs, juices, all secrets. I couldn’t reveal what’s in it. But I know there’s only a handful of people who know (Kon Tiki’s) exact recipe,” Jeffrey Glomski, the current general manager of Kon Tiki, said.

Both Short and the tiki fad were in their fullest powers in the ’60s, when Short opened Kon Tiki, 4625 E. Broadway. Short recruited the acclaimed tiki artist, Milan Guanko, to carve the idol guarding the bar’s entrance and design a signature mug that has, like many in the annals of tiki, become a collector’s item.

Kon Tiki is releasing another collector’s item on Sept. 24. They are celebrating their 60th anniversary with a run of 120 tiki mugs, along with other ephemera like swizzle sticks in the design of the Milan Guanko idol. Flash in the Past Studio is organizing the anniversary party, complete with a DJ set and limited-edition cocktails. Tickets for the event, which starts at 6 p.m., cost $10. Vintage attire is encouraged.

The main dining room inside of Kon Tiki during dinner time on Sept. 7.

Grace Trejo, Arizona Daily Star

“If you ask me what I’d like people to know about the tiki, it’s that there is an oasis, an escape, here in Tucson. It’s just tucked behind trees and buildings. Been here for the last 60 years. And, yeah, you know, it’d be great to see it around for another 60,” Glomski said.

Kon Tiki is the fifth-oldest operational tiki bar in the country. Its peers are all in bigger cities than Tucson: San Francisco, where the tiki trend started; Los Angeles and Chicago.

“It’s a cool place, it’s something different,” Glomski said. “I believe now, we’re only one of two places (in Tucson) that serve that kind of cuisine. Everybody else has closed down. Times are a lot different now than they were 20 years ago. When I started off in this business, it was back in the ’80s, it seemed like people went out more. Now, people are cautious about how they spend their money. Cost of living has gone up, wages, you know, it seems like it’s a whole different place nowadays, you know?”

“It’s been around for 60 years, so people who came there at that time are on their way out, unfortunately. I know that I’ve seen a handful of people who have passed away since I’ve been there who were regulars,” he said.

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Bartender Anna Monosmith prepares a drink for a customer at Kon Tiki on Aug. 5, 2022.

Kelly Presnell, Arizona Daily Star

Kon Tiki might not have made it to 60 without its current owner, Paul Christopher. Christopher started at Kon Tiki as a dishwasher over 30 years ago and worked his way through all the service stations up to bartender. He learned the intricate, in-house variations of famously complex tiki cocktails. When a former owner was looking to sell the bar, Christopher purchased the entire property.

“The owner owning the building is a big thing. Would it have made it through COVID if it wasn’t? Probably not,” Glomski said.

Tiki has a devoted community: while some are interested in the props, the mugs and stage work, others seek mastery of the challenging cocktails. Kon Tiki’s status as the longest established tiki bar in the southwest might have attracted particularly dedicated staff.

The island themed bar at Kon Tiki transports Tucsonans to another place.

Kelly Presnell, Arizona Daily Star 2022

“Y’know, that’s a whole culture out there,” Glomski said.

“There’s definitely a couple of die-hards out there,” Glomski said. “I just recently lost one who moved to Hawaii. That was in the last six months. Daniel (Wadsworth) was there from before when I started there (five years ago), so. He lived and bled tiki. He had a friend who lived out there and was a bartender at some resort. I think he’ll always be a bartender. He’s just that personality.”

Kon Tiki has been serving Tucson for 60 years. 

Chris Coduto, for the Arizona Daily Star 2007

Kon Tiki’s greatest asset also presents a great challenge: time. The decor and drinks, like their scorpion bowls, have been preserved by many generations of owners, bartenders and patrons. Glomski, a chef and former restaurateur, was hired to update the menu, but he had to keep corny classics like monkey on a stick (marinated beef skewers) central to their offerings.

“They basically made their little oasis here in the desert. I’m not going to say the recipes have changed throughout the years to what they are now. (These are) basic recipes you know, from way back then,” Glomski said.

“We try to maintain it as best we can, which can be a challenge at times: plumbing and things like that, you know, erode away over time,” Glomski said.

Kon Tiki, which featured South Sea island and American food, is shown here just before opening for customers in January 1962.

Tucson Citizen

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