The blood sugar problem more than half of Americans over 65 have isn’t diabetes — and 8 in 10 who have it don’t know

by Adrienne Erin

You feel fine. You’re not unusually thirsty, you’re not running to the bathroom at night, and your energy is about what you’d expect for your age. So when your doctor mentions your blood sugar is “a little high,” it’s easy to shrug it off. That shrug is exactly how millions of people slide from prediabetes into type 2 diabetes without ever feeling a thing.

Key Takeaways

  • The most common sign of prediabetes is no sign at all. It usually causes no symptoms, and about 8 in 10 people who have it don’t know.
  • The CDC now estimates 115.2 million U.S. adults, more than 2 in 5, have prediabetes. Among adults 65 and older, it’s 52.1%, or about 31.3 million people.
  • Prediabetes raises your risk of type 2 diabetes, heart disease, and stroke.
  • A simple blood test is the only reliable way to find it. Guidelines recommend testing starting at age 35, and yearly once you have prediabetes.
  • It’s often reversible. In a landmark trial, lifestyle changes cut the risk of type 2 diabetes by 58% overall, and by 71% in people 60 and older.

The warning sign most people are waiting for never comes

Many people assume they’d notice high blood sugar: extreme thirst, frequent urination, blurry vision, exhaustion. Those are classic symptoms of diabetes, often once blood sugar is already well above normal. Prediabetes, the stage before, usually produces nothing you can feel.

That’s why it goes undiagnosed so often. The CDC says about 8 in 10 adults with prediabetes are unaware of it. Awareness has improved only slowly. The share of adults with prediabetes who had ever been told they had it rose from about 6.5% in the mid-2000s to around 17% by 2017 to 2020.

One visible clue exists but is easy to miss: darkened, velvety patches of skin on the back or sides of the neck or in the armpits, called acanthosis nigricans. It’s linked to insulin resistance. But most people with prediabetes never develop it, so its absence means nothing.

How common it really is

Prediabetes means your blood sugar is higher than normal but not yet high enough for a diabetes diagnosis. The CDC’s latest count, released this year, puts it at 115.2 million American adults, up from a previous estimate of about 98 million. Age is one of the biggest risk factors. Just over half of adults 65 and older now fall in the prediabetes range.

That matters beyond diabetes. According to the CDC, prediabetes on its own raises the risk of heart disease and stroke. And if it progresses, type 2 diabetes is the No. 1 cause of kidney failure, lower-limb amputations, and adult blindness in the U.S.

The numbers that tell you where you stand

Prediabetes is diagnosed with a routine blood test. According to the American Diabetes Association, any one of these results puts you in the prediabetes range:

  • A1C (your average blood sugar over about three months): 5.7% to 6.4%
  • Fasting blood sugar (after not eating for at least eight hours): 100 to 125 mg/dL
  • Two-hour glucose tolerance test (after drinking a sugary solution): 140 to 199 mg/dL

An A1C of 5.7% isn’t “almost normal.” It’s the official line where prediabetes begins. If your last lab report showed a number in these ranges and no one followed up, it’s worth asking about.

Who should get tested

The American Diabetes Association’s 2026 Standards of Care recommend testing all adults starting at age 35, and earlier for people with overweight or obesity plus at least one other risk factor. Other risk factors include a family history of diabetes, high blood pressure, low HDL cholesterol or high triglycerides, physical inactivity, a history of gestational diabetes, or heart disease. If your results are normal, retesting at least every three years is reasonable. Once you have prediabetes, the ADA recommends testing yearly.

The U.S. Preventive Services Task Force’s 2021 recommendation is narrower. It advises screening adults 35 to 70 who have overweight or obesity.

The encouraging part: it can often be turned around

Prediabetes is a warning, not a verdict. The Diabetes Prevention Program, a large NIH-funded clinical trial whose main results were published in 2002, found that a structured lifestyle program cut the risk of developing type 2 diabetes by 58% compared with placebo. For participants 60 and older, the reduction was 71%. The program focused on modest weight loss and regular physical activity, and it worked better than the diabetes drug metformin, which lowered risk by 31% overall and appeared ineffective in people 60 and older.

The benefit lasted, too. Ten years later, participants were still about one-third less likely to have developed type 2 diabetes, and those who did develop it got it about four years later on average.

Today, the CDC’s National Diabetes Prevention Program offers a year-long version of that program through community groups, health systems, and online providers, and Medicare covers a version of it for eligible older adults.

What to do with this information

Ask your doctor for an A1C or fasting glucose test if you haven’t had one recently, especially if you’re over 35. Pull up your last lab results and check your numbers against the ranges above. If you’re in the prediabetes range, ask about a CDC-recognized lifestyle change program near you. Small changes, made early, carry the biggest payoff.

This article is for general information and isn’t a substitute for advice from your doctor.

Sources:

Adrienne Erin

Adrienne holds a Bachelor of Science in Kinesiology, where she developed a strong foundation in exercise physiology and human nutrition. Before joining DailyHealthPost, she spent several years writing about health and wellness topics, translating nutrition and fitness research into practical guidance for everyday readers.

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