Did you know that the issue of prediabetes and what it actually means for health is controversial among some physicians and medical groups? Elevated blood sugar was once considered a risk factor for type 2 diabetes, but now it has been elevated into a pre-disease called prediabetes. We are now told that 1 out of 3 Americans are pre-diabetic and 90 percent of us don’t even know it. The main issues are: What does a prediabetes diagnosis mean? Does prediabetes lead to diabetes? How frequently does this occur? Should one treat it with medications? When one thinks about risk factors - then they can usually be modified (e.g. diet, weight loss, exercise), but when something is called a pre-disease - then one thinks treatment (e.g. medicines).
Yes, we all agree that type 2 diabetes is a very serious health problem. But what about prediabetes? What is alarming to some researchers is that the definition of prediabetes has been broadened over the years to include millions more Americans. Also, what is considered prediabetes in the US may not be considered prediabetes in other countries. Keep in mind that the people most involved with promoting a broadening definition of prediabetes and promoting drugs to treat it, have a number of conflicts of interest (financial and scientific).
The site Health News Review covered the topic of prediabetes in Jan. 2017 in a post by Dr. Michael Joyce: BMJ:Can we trust the numbers that define pre-diabetes? Some quotes from that post: "...a meta-analysis of the progression rates of pre-diabetes shows the majority of people did NOT go on to develop diabetes a decade later." "...in an article published in the BMJ, the accuracy of screening for pre-diabetes with fasting blood sugar and glycated hemoglobin is brought into question." ... “Our research looked at both these tests for pre-diabetes and found that neither of them was accurate,” says lead researcher Dr. Trisha Greenhalgh .... "In short, both our ability to predict diabetes with blood tests alone, and do so accurately in people with borderline elevated blood sugars, is questionable. Nonetheless, results from these tests – sometimes interpreted without clinical context – are being used to medicalize a risk factor and create a new medical condition." Yikes!
This past week another thought-provoking article discussed the topic of prediabetes. Note that some experts call the focus on aggressively treating prediabetes as "scaremongering", especially because those promoting aggressive treatment the most are those with conflicts of interest. Centers for Disease Control and Prevention (CDC) data show that progression from prediabetes to diabetes is actually less than 10% in 5 years, and other studies show even slower (lower) rates. And a comprehensive 2018 Cochrane review of studies found that "up to 59% of prediabetes patients returned to normal glycemic values over 1 to 11 years with no treatment whatsoever". (see below) Wow! Excerpts from the article by Charles Piller in the journal Science:
A war on "prediabetes" has created millions of new patients and a tempting opportunity for pharma. But how real is the condition?
The most common chronic disease after obesity, afflicting 84 million Americans and more than 1 billion people worldwide, was born as a public relations catchphrase. In 2001, the PR chief of the American Diabetes Association (ADA) approached Richard Kahn, then the group's chief scientific and medical officer, for help with a vexing problem, Kahn recalls. ADA needed a pitch to persuade complacent doctors and the public to take seriously a slight elevation in blood glucose, which might signal a heightened risk of type 2 diabetes. Raising the alarm wasn't easy, given the condition's abstruse name, impaired glucose tolerance, and lack of symptoms. ...continue reading "Controversies With the Prediabetes Diagnosis"