August 29, 2010

Pre-diabetes vs what?

Some bloggers have done an excellent job of defining pre-diabetes. Our professionals have said that 126 and greater is diabetes and 125 and lower is pre-diabetes. This makes for a good reference point; however, I am not willing to accept that the numbers are right or wrong.

Many doctors are doing us a disservice when they do not investigate further. Tom Ross got me to thinking in his blog of Aug 16, 2010. My thoughts before were - either it is or it isn't diabetes. I still cling to this because I do not like what our medical community is doing with the term pre-diabetes. Patients are not being properly informed nor educated about what to do to prevent or at least delay for the short or long-term, the progress of diabetes.

At the same time, Tom is right that being arbitrary does nothing to improve the situation as both do have problems with blood glucose control or a pancreas that is not able to react properly as it needs to.

A large problem is that our insurance will not cover anything that is less than 126, but will at 126 and above. To them if you are below 126, you do not have diabetes and therefore most insurance companies will deny your claims. But that is fodder for another blog.

Bob Pedersen does very well to lay out his case. He does not accept the analogy some have loosely used about the woman being a little bit pregnant and applying this to diabetes. I like the analogy and I will use it as I believe above 100 to be indicative of diabetes.

Michael Hoskins does not like the term “pre-diabetes” and I agree with him. Why? The medical community is too quick to use terms that let themselves off the hook for not following recommended procedures. This is where Tom's line of thought becomes important. Arbitrary values often miss the underlying problems that our pancreas is having problems that need to be addressed. And our medical community does little to address this issue other that saying that below 126 you have pre-diabetes and often leaving the patient to wonder what that means.

They leave the doctor's office wondering just what the doctor was talking about and why if it is serious, didn't the doctor issue a prescription to help control things or give them more information to make a sound decision of their own about halting the progression to diabetes and larger future problems.

To many the term pre-diabetes is more descriptive that “borderline diabetes” and I have no quarrel here. I will continue to disapprove of the term pre-diabetes and hope that another term, label, or description will evolve that defines the area that means that diabetes is likely and causes doctors to better inform their patients about the seriousness of their medical status.

Now with this written, we should all take the time to read a book by Gretchen Becker titled “What You Need to Know to Keep Diabetes Away – Prediabetes”. She writes an excellent discussion of diabetes and why we get it or don't, and why we should take the steps necessary to prevent diabetes from developing. If you are likely to get diabetes, Gretchen tells us what to do to postpone it from developing or to do for early control to delay the onset of complications for many years.

After reading Gretchen's book, if you decide to use the term Prediabetes, then I will say that you at least have a more thorough understanding of the term.

Even more important is Dr. Bill Quick's blog published August 22, 2010. In it he discusses the various medications being studied for use to treat prediabetes. As of then, there are no medications approved by the Federal Drug Administration (FDA) for the treatment of prediabetes.

Dr. Quick uses the term “off label” to describe the use of diabetes medications being used by patients before diagnosis of diabetes that insurance does not cover and therefore is at the patient's expense. These medications are also not approved by the FDA for use by these patients. His blog is worth reading.

So while the term “prediabetes” is not an official designation by the American Diabetes Association, it is appearing more and more in blogs, articles, and print both on and off the internet. Either the ADA should recognize this term or preferably designate another term which reflects the seriousness of those that are not classified as type 2 diabetes.

Tom Ross is correct in his analysis that below 126 blood glucose readings do indicate cause for concern as the pancreas is not functioning like it should and this needs to be taken seriously.

I am feeling much happier after the article from the August 25 issue of WebMD. The term prediabetes has been discredited by a consensus panel of diabetes experts. I know that this is not the end of the discussion, but the new approach recommended does make good sense. However, the author of the article does not agree and several of the comments agree with him.

I have a feeling that this debate will continue for some time until the American Diabetes Association starts exercising and gets off their lazy sedentary backside and makes a decision. They do not realize how many doctors are not taking numbers below 126 seriously. It is no wonder the patients don't understand.

1 comment:

Brenda F. Bell said...

Depending on the presentation, some people with elevated postprandial glucose may be told they are "insulin resistant" or have "impaired glucose tolerance" -- two separate issues which have lately become code words for (and been considered identical to) "prediabetes".

Like you, I don't believe in a "switch". My strawman is a progression index which I've based on treated and untreated HbA1c; however, I believe there are four separate tests that need to be conducted at regular intervals in cases where a predilection towards Type 2 diabetes may be suspected, or Type 2 has already been diagnosed: (1) Fasting blood glucose (FBG); (2) glycosylated hemoglobin (HbA1c); (3) Oral glucose tolerance test (OGTT); (4) serum insulin levels (both fasting and postprandial). The first tells us if our bodies are setting too high a stress point for our blood glucose levels; the second (if significantly elevated with respsect to the first) can confirm the first or tell us that we are eating the wrong things at the wrong time; the third tells us if we have issues with Phase 1 or Phase 2 insulin response, or both; and the fourth tells us if we have insulin resistance. Even past the range at which any or all of these tests would diagnose us as having Type 2 diabetes mellitus, the correct treatment (which class of medication, what sort of diet, etc.) needs to be based on all of these tests -- not just one or two.

Note that once a diagnosis has been established, regular c-protein tests will also be able to suggest the degree of remaining beta cell function (also important when determining the appropriate treatment regime).