Here is a number worth a second look. According to the CDC’s National Diabetes Statistics Report, updated this September, more than half of adults 65 and older in the United States have prediabetes. That works out to about 31 million people.
And here is the part that matters more. The CDC estimates that 8 in 10 adults with prediabetes have no idea they have it.
November is National Diabetes Month, which makes this a good moment to understand what prediabetes is, why it so often goes unnoticed, and what Medicare will pay for to help you find out where you stand.
What Prediabetes Actually Means
Prediabetes means your blood sugar is higher than normal, but not yet high enough to be called type 2 diabetes. Think of it as a yellow light rather than a red one.
The reason it matters is what comes next. The CDC says prediabetes raises your risk of type 2 diabetes, heart disease, and stroke. Without any changes, many people with prediabetes go on to develop type 2 diabetes within five years.
The encouraging part is built into the name. “Pre” means there is still time. In many cases, this stage can be slowed, stopped, or even reversed.
Why So Many People Never Find Out
Prediabetes usually has no symptoms at all. You can feel perfectly fine, keep your usual routine, and have blood sugar that has been creeping up for years. There is no ache, no fever, nothing that sends you to the doctor.
That is why it is found through a blood test and almost never any other way.
Age is one of the main risk factors. So is being overweight, having a parent or sibling with type 2 diabetes, having high blood pressure, or being less active than you used to be. If a few of those sound familiar, you are in good company. They describe a lot of us.
The Test Is Simple, and Medicare Covers It
The most common test is called an A1C. It is a single blood draw that shows your average blood sugar over the past two to three months, and you do not need to fast beforehand. According to the National Institute of Diabetes and Digestive and Kidney Diseases, an A1C between 5.7 and 6.4 percent means prediabetes. A fasting blood sugar test (100 to 125 mg/dL) can be used instead.
Medicare Part B covers diabetes screening blood tests up to twice a year, and you pay nothing when your provider accepts Medicare, as long as your doctor considers you at risk. Being 65 or older counts as one risk factor on Medicare’s list. Pair it with one more (being overweight, or having a parent or sibling with diabetes) and you qualify. If you have high blood pressure, a history of abnormal cholesterol, obesity, or a past high blood sugar reading, that alone qualifies you.
If it has been more than a year since anyone checked, ask at your next appointment. It takes a minute.
What Happens If the Number Is High
This is where the story turns hopeful, and the evidence is unusually strong.
More than two decades ago, the National Institutes of Health ran a landmark study called the Diabetes Prevention Program. People with prediabetes were coached on eating better, moving more, and losing a modest amount of weight. Over about three years, that group lowered its chances of developing type 2 diabetes by 58 percent compared with people who took a placebo pill.
Here is the detail that should catch your eye. For participants 60 and older, the reduction was 71 percent. The program worked best for people our age.
The goals were modest. Lose about 5 to 7 percent of your starting weight (10 to 14 pounds for someone who weighs 200) and get about 150 minutes of physical activity a week, which is a half-hour walk five days out of seven.
Medicare Will Pay for the Program Too
That same approach is now offered nationwide as the Medicare Diabetes Prevention Program. If you have Medicare Part B or a Medicare Advantage plan, you can take it once in your lifetime at no cost.
Here is how it works, according to Medicare.gov:
- It begins with up to 16 weekly group sessions over six months, with follow-up sessions after that to help the changes stick.
- A trained coach leads the group and helps you make realistic changes to eating and activity.
- You can attend in person, online, or a mix of both.
- To qualify, you need a prediabetes-range blood test result within the past 12 months (an A1C of 5.7 to 6.4 percent, or a fasting glucose of 110 to 125), a body mass index of 25 or more (23 or more if you are Asian), and no previous diagnosis of type 1 or type 2 diabetes or end-stage kidney disease.
Ask your doctor for a referral to an approved Medicare Diabetes Prevention Program supplier. If you are in a Medicare Advantage plan, call the plan to ask where the program is offered.
The Bottom Line
More than half of people 65 and older are living with prediabetes, and most have never heard the word applied to them. The test is one tube of blood. The program that, in the original study, cut the risk by nearly three-quarters for people 60 and older is free. Both are covered.
Prediabetes is one of the few health conditions where finding out early changes almost everything. This month, ask the question.
