Academics say the term ‘pre-diabetes’ is artificial and unhelpful

by Barbara Hewitt on August 7, 2014

Labelling people with moderately high blood sugar as pre-diabetic is a drastically premature measure with no medical value and huge financial and social costs, it is claimed.

Type 2 diabetes is usually diagnosed with a blood test that measures levels of haemoglobin A1c with a level of 6.5% regarded as diabetic. According to the latest guidelines from the American Diabetes Association (ADA), anyone with an A1c between 5.7% and 6.4% should be regarded as having pre-diabetes.


Researchers say there are no long-term benefits to labeling a patient ‘pre-diabetic’

But this is not a label that everyone is happy with. For example, the World Health Organisation (WHO) discourages the use of the term to avoid any stigma associated with the word diabetes and the fact that many people do not progress to diabetes as the term implies. Also, guidance from the UK National Institute for Health and Care Excellence (NICE) broadly aligns with the WHO statement, suggesting the medical profession should move away from describing pre-diabetes as a separate condition.

Now, researchers from University College London and the Mayo Clinic in Minnesota, United States, have looked at whether a diagnosis of pre-diabetes carries any health benefits such as improved diabetes prevention. The authors showed that treatments to reduce blood sugar only delayed the onset of type 2 diabetes by a few years, and found no evidence of long term health benefits.

They pointed out that if the ADA guidelines were adopted worldwide, a third of the UK adult population and more than half of adults in China would be diagnosed with pre-diabetes. They question the logic of putting a label on such huge sections of the population, as it could create significant burdens on healthcare systems without conferring any health benefits. Previous research has shown that type 2 diabetes treatments can do more harm than good for people with A1c levels around 6.5%, let alone those below this level.

Some 3.2 million people in the UK are currently diagnosed with type 2 diabetes, but approximately 16 million would fall into the ADA’s pre-diabetes category. There is a condition known as impaired glucose tolerance (IGT) that affects around 3.7 million adults in the UK (8%). People with IGT are at high risk of diabetes, but the test is more time-consuming than a simple A1c blood test. There is evidence to suggest that interventions can delay the progression of IGT into diabetes, but the ADA category of pre-diabetes also includes another 12 million people who are at a much lower risk of progressing to diabetes, for whom any benefit from treatment is unknown.

“Pre-diabetes is an artificial category with virtually zero clinical relevance. 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,” said John Yudkin, emeritus professor of medicine at UCL.

“Sensibly, the WHO and NICE and the International Diabetes Federation do not recognise pre-diabetes at present, but I am concerned about the rising influence of the term. It has been used in many scientific papers across the world, and has been applied to a third of adults in the UK and half of those in China,” he pointed out.

“We need to stop looking at this as a clinical problem with pharmaceutical solutions and focus on improving public health. The whole population would benefit from a more healthy diet and more physical activity, so it makes no sense to single out so many people and tell them that they have a disease,” he added.

A healthy diet and physical activity remain the best ways to prevent and to tackle diabetes, according to co-author Victor Montori, professor of medicine at the Mayo Clinic. “Unlike drugs they are associated with incredibly positive effects in other aspects of life. We need to keep making efforts to increase the overall health of the population, by measures involving public policy rather than by labelling large sub-sections of the population as having an illness. This is a not a problem to be solved at the bedside or in the doctor’s surgery, but rather by communities committed to the health of their citizens,” she said.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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