The Escalating — and Useless — Diagnosis of “Pre-Diabetes”

Like most chronic illnesses, diabetes is treated most successfully when diagnosed early. But too many people are being given a diagnosis of “pre-diabetes,” which not only subjects them to unnecessary treatment, but places unsustainable burdens on the health-care infrastructure.

The title of a commentary published last month in the journal BMJ pretty much summed up the problem: “Too Much Medicine,” by Dr. Victor Montori, an endocrinologist who specializes in diabetes at the Mayo Clinic, and Dr. John Yudkin, an emeritus professor of medicine at University College London, calls a diagnosis of pre-diabetes dubious. It’s an important assessment, because a dubious diagnosis is an unreliable predictor of who will actually develop the disease.

“Pre-diabetes is an artificial category with virtually zero clinical relevance,” the Minnesota Post reported in a news statement Yudkin released when the commentary appeared. “There is no proven benefit of giving diabetes treatment drugs to people in this category before they develop diabetes, particularly since many of them would not go on to develop diabetes anyway.”

As we regularly write, overtreatment, which is what the writers are dealing with here, is not just inefficient and wasteful, but leads to unnecessary worry and the possibility of complications from procedures that stem from this unacceptably aggressive use of medical care.

Rather than turning people who are at risk of developing diabetes into patients who are given inappropriate care, the writers argue that those resources should be directed toward educating this population on how to prevent the disorder. That means helping them understand the role of diet and exercise in developing diabetes. It also means expending energy on public policies that address the obesity epidemic that promotes diabetes.

The artificial problem is the result of one segment of the medical industrial complex – the American Diabetes Association – lowering the threshold for what is defined as disease, and it’s disgraceful.

Diabetes is diagnosed when levels of blood glucose, or blood sugar, are too high. It’s a hormonal disorder – the hormone insulin helps deliver necessary amounts of energy (glucose) to cells, but sometimes the body does not make enough. That’s type 1 diabetes, a condition that usually develops when you’re young.

Type 2 diabetes is more common, and develops later in life, when the body doesn’t make enough insulin or doesn’t use what it makes properly. It’s often promoted – and controlled – by lifestyle habits
A deficiency of insulin means that glucose stays in the blood, and if the condition persists too long, can cause a host of problems including:

  • heart disease;
  • stroke;
  • compromised kidney function;
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