Diabetes Self-Management Blog

The statistics are alarming: According to a recent study, 35% of adults in England had prediabetes in 2011, up from just 12% in 2003. The situation in the United States is no better: The American Diabetes Association (ADA) estimates that 37% of American adults had prediabetes in 2012, including 51% of adults ages 65 and above. But what exactly does it mean to have prediabetes? A new article suggests that this diagnosis is overhyped and should probably be scrapped.

Published in the medical journal BMJ, the article — written by two professors of medicine, one British and one American — asserts that the definition of prediabetes has become too broad to be useful. According to a report on the article at Medical News Today, the authors considered whether a diagnosis of prediabetes has been shown to improve any health outcomes. They found that while treatments for prediabetes (usually dietary changes and exercise, but sometimes also the drug metformin) delayed the onset of Type 2 diabetes by a few years in many cases, there was no evidence of long-term health benefits resulting from a diagnosis of prediabetes. In fact, the ADA is the only medical organization that provides criteria for diagnosing prediabetes — both the World Health Organization (WHO) and Britain’s standard-setting body, known as NICE, do not recognize prediabetes as a condition and discourage the use of the word. However, due to the ADA’s worldwide influence, doctors and researchers around the world have been examining prediabetes using the ADA’s guidelines.

As the authors of the article note, the ADA’s current guidelines for diagnosing prediabetes are quite new, adopted only in 2010. The first category of “sub-diabetes,” called impaired glucose tolerance, was created in 1979 and was defined as a result of 140–200 mg/dl from an oral glucose tolerance test (with higher than 200 mg/dl indicating diabetes). But since oral glucose tolerance tests are time-consuming and unpleasant, in 1997 the ADA, along with the WHO, created standards for diagnosing both diabetes and a new “sub-diabetes” category, called impaired fasting glucose, defined as a result of 110–125 mg/dl from a fasting blood glucose test (with higher than 125 mg/dl indicating diabetes). Then, in 2003, the ADA lowered its threshold for impaired fasting glucose to 100 mg/dl. And in 2009, the ADA set the criteria for prediabetes — its first use of the term as an official diagnosis — as an HbA1c level of 6.0% to 6.5% (with higher than 6.5% indicating diabetes). The next year, the ADA lowered the threshold for prediabetes to an HbA1c level of 5.7%.

The authors of the BMJ article warn that having the diagnostic category of prediabetes invites pharmaceutical companies, and by extension doctors, to treat the condition using drugs — even though a focus on diet and exercise is more important. Furthermore, with so many people falling under the prediabetes umbrella — and with a relatively weak relationship between having prediabetes and developing diabetes within ten years — the authors conclude that the term is simply not useful, and that efforts to improve diet and exercise habits should be focused on the entire population. This change in focus, they suggest, would reduce diabetes rates more effectively than singling out 35% or 37% of the population.

What do you think — is the term “prediabetes” useless, if all you’re supposed to do is improve your diet and exercise, or is it a useful motivator to make lifestyle changes? If you have Type 2 diabetes, were you previously diagnosed with prediabetes (or another variant of “sub-diabetes”)? Do you think this diagnosis had — or would have had — any effect on you, positive or negative? Should an increase in the rate of prediabetes be seen as alarming, even if diabetes rates aren’t rising as fast? Leave a comment below!

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Comments
  1. Prediabetes is stage 1 diabetes. Just as you say stage 1 cancer. Just as you can’t be “a little bit pregnant.” To call it anything else is to lull doctors and patients into downplaying the seriousness of this condition. See Riva Greenberg’s recent article, The Lie That’s Killing Us: Pre-Diabetes, at:

    http://www.huffingtonpost.com/riva-greenberg/prediabetes_b_3023146.html

    Posted by Catherine L. |
  2. as was said you either are diabetic or you are not they say cholesterol causes heart problems and say you just had a minor heart attack a heart attack is a heart attack with all this extra hoohah going on it gives people a little more time to get used to the idea meanwhile not bothering with it let’s call aces aces and spades spades and get one with getting it under control

    Posted by marylittle |
  3. If your A1c and blood glucose readings are higher than normal, you have a problem that needs to be addressed. Who cares what name you slap on it.
    None of the readings in this article are normal — reason for concern.

    A good place to start would for your Doctor to tell you to load up on high carb foods before your appointment (when not getting blood tests) and take a reading with a glucose meter. Simple but it would let your Doctor know if action is required. Maybe it should be called insulin challenged… The term diabetic does seem to be way over used and is rather scary to many. Research shows any reading over 140 mg/dl (7.8) is probably damaging your body.

    Posted by JohnC |
  4. yes. I was prediabetic for so many years, more than a decade, it came to be meaningless. Plus no care or education classes are provided, or covered by insurance, until one is diabetic, as I became at age 67.

    Maybe if the definition were tighter preventative care might be authorized and fewer of us might become diabetic.

    Posted by joan |

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