- In a published editorial, public health experts said they believe doctors should be more cautious in diagnosing prediabetes, given the potential harm it can cause.
- But in a second editorial, another expert said prediabetes can lead to serious health problems and should be diagnosed early, if necessary.
- Other experts say treatment for prediabetes should be tailored to each patient, with lifestyle factors being the first-line treatment and drug therapy being considered when lifestyle changes are ineffective..
Is prediabetes being overdiagnosed?
Experts are divided on how and when to test for this potential harbinger of type 2 diabetes, disagreeing in two opposing opinion articles published in the journal Neurology today. Yearbook.
In one editorial, Rani MarxThe Slow Medicine Initiative director, an epidemiologist and PhD, argues that prediabetes can sometimes be diagnosed too early, which can do more harm than good.
She points out that being told by a medical professional that you have prediabetes can be stressful, as many people mistakenly assume that their condition will automatically progress to type 2 diabetes, she says.
Marx said the diagnosis could lead people to unnecessary doctor's visits and lab tests, which could result in additional costs, such as copayments and co-pays.
Opposite editorial, Dr. Jonathan GabisonThe assistant professor in the Department of Family Medicine at the University of Michigan suggests that prediabetes is a critical stage in health that medical professionals should address and treat early.
Gabison said prediabetes can be an early sign of metabolic syndrome, which increases the risk of cardiovascular disease, several common cancers and neurocognitive disorders.
Both authors agree that type 2 diabetes is a preventable disease.
But Gabison and Marx don't necessarily agree on who is at high risk and who might be appropriate candidates for preventive intervention.
“Prediabetes is not an emergency, but an opportunity to assess and minimize long-term risk. Before we jump into treatment, we look at other indicators of metabolic health to make sure individuals are at increased risk,” Gabbison said. Today's Medical News“Prediabetes should be addressed through lifestyle changes, primarily focusing on improving nutrition, physical activity and sleep patterns.”
“Treatment will vary from person to person, but when lifestyle changes are insufficient or difficult to implement, identifying the underlying barriers becomes important,” he added. “In such cases, pharmacotherapy may be considered as part of a comprehensive plan to manage or reverse prediabetes or overcome the barrier. Understanding an individual's lifestyle and underlying causes is key to effective treatment.”
Other experts say a more specific definition and the ability to tailor treatment to individuals is needed.
“The authors raise very important questions about the poor correlation between diagnoses and definitions of glycemic abnormalities according to current criteria,” they say. Dr. Eliud Sifonte “When applying population-based study results to clinical practice, it is always important to consider other factors that may be contributing to a particular test result or patient situation,” said Dr.
“The example provided by the authors highlights the need for more specific definitions at the guideline level, but at the same time, it is a good example of why elevated hemoglobin A1C despite a seemingly healthy lifestyle requires individualized care by physicians and the need to refer patients to a specialist, such as an endocrinologist, for further evaluation,” said Dr. Sifonte. Today's Medical News“In situations like this example, it is also advisable to consult a dietitian to review your eating patterns. In these and similar cases, obtaining a 1-hour blood glucose value after a 75-gram glucose load can be crucial.”
In March 2024, Food and Drug Administration To help people with diabetes track their blood sugar levels, the government has authorized the sale of over-the-counter continuous glucose monitors, which previously were only available with a prescription.
“We think this is a potential problem.” Dr. Pooya ShafipourPhysician in Family Medicine and Bariatric Medicine at Saint John's Health Center in Providence, California.
“People sometimes scare themselves by using these machines without understanding how to use them or interpret the results,” Shafipour said. Today's Medical News“They may not realize that exercise or a hot shower can raise their A1C, and then they see their numbers going up and panic. I don't have diabetes, but I've taken an A1C before, so I understand why this happens. [a monitor] I should have been notified. My numbers were high and it concerned me. I am a physician who treats this condition regularly. I think people should be very careful if they use these without coordinating with their physician.”
Prediabetes refers to a condition in which blood sugar levels are higher than normal but not high enough to be in the diabetic range. American Diabetes Association.
Because type 2 diabetes progresses over time, many people with prediabetes are at risk of developing diabetes. However, not everyone with prediabetes will progress to diabetes, especially with lifestyle changes. Prediabetes does not have clearly defined symptoms, so people notice it when they have regular blood tests that include testing their blood sugar levels.
A1C levels are also important: a level between 5.6% and 6.4% indicates prediabetes, while anything above 6.4% is considered diabetes.
“A single A1C test is not an indication of prediabetes,” Shafipour explains. “If it's between 5.6% and 6.4%, we look at potential causes, like medication side effects. We also look at dietary habits, including a 24-hour memory of what you ate and how much exercise you did.”
“The first step is to provide guidance and suggest modifications if necessary,” Shafior says, “and then test again in a few weeks, without, of course, wanting to scare or overstress people.”
Prediabetes occurs when the body can't use insulin effectively. Insulin regulates blood sugar levels, and when this process doesn't work, you end up with high blood sugar.
People with prediabetes are at higher risk of developing type 2 diabetes.
People at higher risk of prediabetes include those who:
Additionally, women with polycystic ovary syndrome, gestational diabetes, or who give birth to a baby weighing more than 9 pounds are also at higher risk for developing prediabetes or diabetes.
However, not everyone with prediabetes will go on to develop type 2 diabetes, and lifestyle changes such as daily exercise and a healthy diet can help delay or prevent the onset of diabetes.
“I'm not a clinician so I can't comment on treatment,” Marx said. Today's Medical News“However, based on the scientific literature and my own experience as a patient, I believe that low-risk individuals who would be classified as prediabetic according to CDC guidelines should not fear that they have the disease or are on an inevitable path to diabetes. Rather, they should have careful discussions with their clinicians about risk factors for developing the disease and healthy lifestyle choices.”