March 08, 2019, 10:58 AM
sjtillDubious Diagnosis: Should “prediabetes” be treated? Questionable evidence of benefit
I used to be in charge of preventive medicine guidelines for a very large multi specialty group practices in California. We spent a great deal of time and effort examining the scientific evidence of benefit vs harm of many medical interventions designed to prevent illness. It turned out that only a few were clearly beneficial compared with the harm (anxiety and financial cost of being a “patient”).
Every time we read of new guidelines that suggest that a larger and larger percent of the population needs to be treated for some condition, we should be skeptical. How many people need to be treated to prevent death or severe illness from that condition? 10? 100? 1000? These numbers are rarely published or publicized.
Here is a long but interesting article from Science Magazine that raises serious questions about the push to put people with “prediabetes” on metformin, a diabetes drug. It confirms what I have suspected: the benefits are questionable for those not at very high risk for developing diabetes, and unproven at that.
quote:
The push to diagnose and treat prediabetes has come at a cost. When told they have the condition, many people face psychological and financial burdens trying to address it. ADA, CDC, and other groups have spent billions of dollars on research, education, and health improvement programs—generally focused on weight loss and exercise—that have generated lackluster results, according to critics. Kahn makes the point with rhetorical bluntness: Spending vast sums of public money on such prevention programs "has nearly the same effect as burning it in a fire … overall, [it's] a terrible waste of money."
To lower blood sugar, ADA has increasingly advocated more aggressive measures, such as prescription drugs—a push that has opened it to charges of conflicts of interest. Science found that the group and its experts who promote aggressive treatment of prediabetes accept large amounts of funding from diabetes drugmakers. So far, no drugs have been approved specifically for prediabetes, meaning that doctors are limited to prescribing diabetes drugs or other medications "off label" to treat the condition. But drug companies are testing dozens of drugs aimed at prediabetes in hopes of tapping a potential worldwide market of hundreds of millions of people.
Given the avalanche of questionable spending and the wave of anxiety it has unleashed, Kahn now says he rues the day he helped promote the term prediabetes, calling it "a big mistake."
LinkMarch 08, 2019, 11:11 AM
ZSMICHAELThanks for posting. I am fortunate that my physician understands the "work" of being a patient. Controlling blood pressure to the point where the patient feels terrible all the time could be another example. The guidelines seem to be lowered all of the time. JMHO
March 08, 2019, 11:25 AM
smithnsigPrediabetes is the most treatable "disease" there is with diet, because it is caused by diet.
I'm learning about insulin response, resistance, blood sugar etc. The food pyramid needs to be reversed. When that happens, a lot of metabolic diseases will go away.
March 08, 2019, 12:38 PM
Pipe SmokerI consume little sugar – easy for me since I don’t have a sweet tooth. And lots of fiber in my diet.
March 08, 2019, 12:47 PM
GustoferBeen saying it for years. Not 10-12 years ago, normal BG was 120ish and a normal A1C was 7.0. Now they are 100 and 5.7.
What has this accomplished?
Thousands, if not hundreds of thousands of healthy people are being treated for a condition for which they don't have.
LDLs are another one. I know cardiologists who aggressively treat anyone over a value of 70. Ridiculous IMO.
March 08, 2019, 12:50 PM
MNSIGquote:
Originally posted by smithnsig:
Prediabetes is the most treatable "disease" there is with diet, because it is caused by diet.
I'm learning about insulin response, resistance, blood sugar etc. The food pyramid needs to be reversed. When that happens, a lot of metabolic diseases will go away.
I think the point is that it is "caused" by the lowering of target numbers. No one has ever lost their eyesight or a finger/toe at a FBG of 105, yet that makes one "pre-diabetic". The diagnosis should not even exist.