At least this is not a study, but an
analysis by “experts.” They are talking about the two parts –
the medicine and the politics of prediabetes. The article is part of
a series in the British Medical Journal on over diagnosis.
They say that the risks and harms to patients will depend in
expanding disease definitions. They began their analysis by
reminding the reader that prediabetes is a heterogeneous concept or a
concept composed of parts of different kinds, having widely
dissimilar elements or constituents:
“Concept one” - The original
category of intermediate hyperglycemia was termed "impaired
glucose tolerance" and was based on the oral glucose tolerance
test. Only since 1997 was an intermediate category of "impaired
fasting glucose" created, “concept two” with revision in
2003 to expand the range of qualifying values. “Concept three”
Because A1c was not used for diagnostic testing until 2010; it is
only recently that a nameless intermediate category based on A1c was
designated. Unfortunately, the overlap of these three definitions is
far from perfect, so the starting point for the discussion is already
confused. This is the interpretation of the experts.
They declare there is a limited value
of prediabetes. They said the importance was whether a diagnosis of
prediabetes guarantees a future diagnosis of diabetes. They declare
that no matter how prediabetes is defined, the answer is “no” -
less than one-half of all such people will develop diabetes within 10
years. The two authors say that clinical trials from around the
world have demonstrated that diabetes risk among high-risk
individuals can indeed be reduced, but Yudkin and Montori argue that
diabetes onset was merely delayed by 2-4 years, at high cost and only
among a subset of the intervention groups.
“The following quote summarizes their
position: "The US Diabetes Prevention Program results imply
that you can give an at-risk person with pre-diabetes a 100% chance
of using metformin with the goal of reducing by 31% their risk of
developing a condition that might require them to use metformin."
Yudkin and Montori conclude that it is critically important to
address the epidemic of obesity and diabetes. However, they assert
that available resources should be used to change the root causes of
the epidemic rather than to medicalize otherwise healthy patients
with prediabetes.”
Then they switch to a study published
in Diabetes Care about the risk of cardiovascular disease
(CVD) in people with prediabetes. “The Diabetes Prevention
Program Outcomes Study (DPPOS) is the follow-up to a randomized
clinical trial of individuals who had prediabetes. Of the 2775
participants in DPPOS, 1509 (54%) had achieved normal glucose
regulation (NGR) at least once during the DPP, whereas 496 (18%)
remained with prediabetes and 770 (28%) developed diabetes. The
investigators also compared individual CVD risk factors, including
cholesterol, smoking status, blood pressure, and diabetes status, all
assessed annually.”
What bothers me is that 54 percent of
people with prediabetes do have problems with high blood pressure and
need medications and 34 percent used statins and these “experts”
say we should not be concerned with prediabetes. Yes, this does mean
that possibly some may be medicated that should not be, but if they
could focus on those with the greatest risk factors then some would
be missed, but many would be helped.
Maybe the new method of determining
diabetes need to be put in place as this would be a great diagnostic
tool and could more accurately tell which people with prediabetes
were at risk. Read my blog here about the possible new test.
It is my opinion that these “experts”
should support testing people for prediabetes and using every test
possible to find those at risk for developing type 2 diabetes.
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