Older Adults That Have Prediabetes, Low Education Levels at Highest Risk for Cardiovascular Complications

Now, a UB study published in August in Aging-US.com has examined how multiple social risk factors in older adults with prediabetes may put them at increased risk for cardiovascular complications.

“In addition to the higher risk of progression to Type 2 diabetes seen in older adults with prediabetes, there is also a strong association with cardiovascular complications,” says Obinna Ekwunife, PhD, first author and assistant professor of medicine, in the Division of Population Health at the Jacobs School of Medicine and Biomedical Sciences at UB. “Older adults often face multiple overlapping social and health challenges that can accelerate poor cardiovascular health outcomes, so understanding how social risk factors contribute is important.”

The research was based on the University of Michigan’s Health and Retirement Study of 5,086 adults aged 50 years and older with prediabetes. The five social risk domains that were studied were economic stability, environment, education, health care and social context.

Cardiovascular risk factors included blood sugar control as seen in the 90-day average known as HbA1c, systolic blood pressure and cholesterol ratio. The UB researchers assessed relationships between social risk factors and these cardiovascular outcomes after adjusting for age, gender, race and marital status.

“Our study found that limited education — defined as those who did not graduate high school — consistently predicted worse outcomes across all three major cardiometabolic indicators: glycemic control, blood pressure and cholesterol,” says Ekwunife. “This makes education stand out as a particularly powerful social risk factor, even when other risks like financial strain or lack of insurance were considered.”

The study also found that while low education was the single most powerful factor, economic instability was also a significant risk factor for worse cardiovascular outcomes.

Ekwunife explains how education levels can influence health in interconnected ways. “Lower educational attainment can limit income and job opportunities, increase exposure to stressful or unhealthy environments, and reduce health literacy,” he says. “This combination makes it harder to understand and follow prevention or treatment plans, afford healthier food and access resources, ultimately worsening cardiovascular health outcomes.”

For older adults, he notes, mitigation obviously does not mean going back to school but rather ensuring they receive information and care in clear, accessible ways.

Strategies discussed in the paper include:

• Simplified, culturally appropriate health education.
• Peer and community support programs to reinforce healthy behaviors. The researchers note that tailored diabetes-prevention interventions for high-risk groups, such as those with limited education or economic resources, are particularly important for bridging health equity gaps.
• Use of technology and health navigators to bridge knowledge gaps.
• Policy interventions, such as including prediabetes in Medicaid waiver programs that provide supportive services.

“Clinicians should recognize that social risks, especially low education, are not just sociodemographic factors but active drivers of poor health outcomes in prediabetes,” concludes Ekwunife. “Screening for social needs, tailoring communication and connecting patients with resources can make a real difference. For older patients, the key message is that managing prediabetes goes beyond medications and lifestyle; asking for support, clarifications and resources is just as important as medical care.”

The study’s corresponding author is Leonard E. Egede, MD, Charles and Mary Bauer Endowed Chair and professor of medicine in the Jacobs School. Other co-authors are Jennifer A. Campbell, PhD, MPH, associate professor of medicine; Raphael Fraser, PhD,  research associate professor of medicine; Yilin Xu, data manager/statistician; and Rebekah J. Walker, PhD, associate professor of medicine and division chief, all of the Division of Population Health in the Jacobs School; and David M. Jacobs, PharmD, PhD, in the School of Pharmacy and Pharmaceutical Sciences.

The research was funded by the National Institute of Diabetes and Digestive Kidney Disease and the National Institute for Minority Health and Health Disparities.