Is Online Prediabetes Screening Reliable?

Here at Diabetes Flashpoints, we’ve previously discussed some of the controversy surrounding a diagnosis of prediabetes — elevated blood glucose that isn’t high enough for a diagnosis of Type 2 diabetes. As we noted in that post, the American Diabetes Association (ADA) is virtually alone in recognizing prediabetes as a condition — the World Health Organization, for example, discourages use of the term and provides no diagnostic criteria. But due to the ADA’s influence worldwide, more and more doctors both in and outside the United States appear to be diagnosing prediabetes.

Now, it seems that the ADA — in partnership with other American medical organizations — is doubling down on its emphasis of the dangers of prediabetes. A few months ago, it teamed up with the American Medical Association, the Centers for Disease Control and Prevention, and the Ad Council to create an online quiz that aims to estimate a person’s risk of developing prediabetes. The seven-question test asks participants about their gender, family history of diabetes, blood pressure, age, ethnicity, physical activity, and height and weight. As the home page of the quiz notes, “1 in 3 American adults has prediabetes” — and the quiz’s sponsors hope that this third of the population will visit their doctor if the quiz suggests a high risk of prediabetes.

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As a HealthDay article on the quiz notes, over a third of adults who take the quiz may end up having prediabetes. But according to an article published earlier this week in the journal JAMA Internal Medicine, about 60% of American adults age 40 or over — and over 80% of those age 60 or older — are likely to get a “high risk” result from the prediabetes quiz. To arrive at these numbers, researchers analyzed the results of questions similar to those in the prediabetes quiz that were asked as part of the National Health and Nutrition Examination Survey. That study matched health outcomes — like blood glucose levels — with questions asked of participants.

The authors of the JAMA article conclude that because the clear majority of adults who take the online quiz will most likely be flagged as potentially having prediabetes, the quiz isn’t very useful. Instead, they argue, the organizations that sponsor the quiz would be better off focusing their resources on encouraging screening for people who may actually have Type 2 diabetes and other diseases, rather than merely “pre-” conditions. Separately, MedPage Today also features a short video of a doctor making his case against the usefulness of the online quiz.

What’s your take on this screening questionnaire for prediabetes — do you think it could be a useful tool, or would it be more effective to simply encourage people to talk to their doctors about their risk level? Do you think you’d be more likely to ask your doctor about getting tested for prediabetes (or diabetes) if you took such a quiz online? If you were told you had prediabetes before you received a diabetes diagnosis, was this information helpful? Leave a comment below!