Is prediabetes really a medical condition that needs attention?
Charles Piller, a contributing correspondent for Science, has published a news article in the journal questioning the medical soundness of referring to prediabetes as a condition that needs treatment. In his article, he points out that there is little to no scientific evidence linking prediabetes to diabetes. He also notes that prediabetes has not been found to cause health problems in people who have been so diagnosed.
Piller outlines the history of the coinage of the term, relating that it came about as representatives from the American Diabetes Association (ADA) and other diabetes-related institutions met to discuss the possible implications of patients with above-normal levels of glucose in their blood. The fear was that prediabetes would lead to full-blown diabetes and thus there existed an opportunity to prevent the disease if prediabetes could be treated.
Piller argues that the problem was a lack of evidence to suggest that might be the case. But that did not stop the CDC and many other institutions from adopting the term and using it as a warning marker for people with elevated glucose levels. Piller also suggests another problem. The ADA is a nonprofit organization and relies on donations to survive. Much of those funds, he found, come from pharmaceutical companies that sell drugs such as metformin, which have been developed to reduce the damage that diabetes does to the body.
Piller reports that in recent years, the ADA has lowered the conditions required to be diagnosed as prediabetic, resulting in far more people being diagnosed as such, a move he suggests could have been due to pressure from its pharmaceutical partners hoping to cash in on treatment products. This is because some doctors have begun prescribing medications to patients diagnosed as prediabetic. Some have even begun to prescribe drugs such as metformin to patients who do not even have diabetes, all in the name of preventing them from getting it.
But not everyone is on the prediabetes bandwagon, Piller points out. The World Health Organization has rejected it as a diagnosis, as have many other institutions around the world. There is also trouble with the numbers—tens of millions of people have been diagnosed as prediabetic, far more than will ever develop the disease. He cites an example: approximately 16 million people in the U.K. have been diagnosed as prediabetic, but only 3.3 million people there actually have type 2 diabetes.
He concludes by suggesting that coinage of the term has led to classifying many healthy people as having an illness, which has led to negative consequences for them such as financial losses due to having to pay for care, and unnecessary anxiety.
More information: Charles Piller. Dubious diagnosis, Science (2019). DOI: 10.1126/science.363.6431.1026
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