Investigative Report Calls Prediabetes A ‘Dubious Diagnosis’
Prediabetes affects one in three Americans, according to the Centers for Disease Control and Prevention. But an investigative report in the journal "Science" says the diagnosis is misleading, expensive and potentially dangerous.
The American Diabetes Association (ADA) coined the term "prediabetes" in 2001 to raise awareness of a condition that can increase risks of cardiovascular disease and type 2 diabetes but often causes no symptoms.
But some experts consider the underlying evidence for those risks, and for the efficacy of current treatments, too weak to justify higher costs and potential overprescription of obesity drugs or diabetes drugs such as metformin.
Lawrence Mandarino, chief of the division of Endocrinology at the University of Arizona College of Medicine, says the paper, though simplistic, raises valid points.
He also said the diagnosis could motivate people to make positive change.
"I don't think it's a terrible thing to tell people that they have an elevated risk for type 2 diabetes if it leads them to improve their eating and improve their physical activity."
Dr. Mandarino added that doctors must consider many risk factors, including the patient's family history, ethnicity and sociodemographic aspects, in their diagnoses and treatment plans.
Simplistic or not, the papers concerns take on new weight in light of the growing number of prediabetes patients — stemming from the ADA's expanded diagnostic criteria — and concerns over conflicts of interest with pharmaceutical companies.
A 2013 paper in the journal "PLOS ONE" singled out the ADA as having a "particularly high" number of authors involved in developing clinical practice guidelines who held a financial interest in the company whose drug they recommended.
That paper could not establish a significant relationship between those interests and a given drug recommendation, but the authors argued that the existence of such interests placed the credibility of such guidelines "in doubt."