Originally published July 19 2014
'Prediabetes' diagnosis carries huge financial and social costs with no medical value
by David Gutierrez, staff writer
(NaturalNews) The diagnosis of "prediabetic," as recommended by the American Diabetes Association (ADA), has no clinical value and may actually cause harm, according to a research review conducted by scientists from University College London and the Mayo Clinic in Minnesota and published in the journal BMJ.
Only drug companies benefitLevels of hemoglobin A1c are used to indicate a person's average blood sugar level over the previous three months, which is why the test is commonly used to diagnose type 2 diabetes. A score of 6.5 percent or higher is widely considered indicative of diabetes.
According to the ADA, a person with hemoglobin A1c levels between 5.7 and 6.4 percent should be classified as "prediabetic" and should be treated with drugs to prevent them from developing full-blown diabetes.
Widespread adoption of this recommendation would have dramatic effects. For example, while 3.2 million people in the United Kingdom are currently classified as type 2 diabetic, the ADA guidelines would classify another 16 million as prediabetic, or one-third of the country's population. Under ADA guidelines, fully half the population of China would be considered prediabetic and should be treated with diabetes drugs.
Of the 16 million "prediabetic" people in the UK, about 3.7 million have a condition known as impaired glucose tolerance (IGT). Studies into treatment of IGT with the diabetes drug metformin have shown that, while the drug did reduce the risk of developing diabetes by 31 percent over the course of 2.8 years, this appears to only delay diabetes onset, not prevent it. There is also no evidence that beginning metformin treatment this early -- rather than waiting for an actual diabetes diagnosis -- provides any health benefit.
For the more than 12 million UK residents with "prediabetes" but without IGF, absolutely no benefit to diabetes treatment has ever been shown.
In fact, studies have shown that metformin and other diabetes drugs may actually do more harm than good even for people with A1c just above the 6.5 percent cutoff for a diabetes diagnosis, suggesting that perhaps the threshold for diagnosis may actually be too low, not too high.
"The ADA recommends treating pre-diabetes with metformin, but the majority of people would receive absolutely no benefit," lead author John S. Yudkin said.
"There are significant financial, social and emotional costs involved with labelling and treating people in this way. And a range of newer and more expensive drugs are being explored as treatments for 'pre-diabetes.' The main beneficiaries of such recommendations would be the drug manufacturers, whose available market suddenly leaps to include significant swathes of the population. This is particularly true in emerging economies such as China and India, where regulating the healthcare market is a significant challenge."
Diet and exercise are for everyoneThe paper raises concerns that the very term prediabetes may be causing harm on both an individual and society-wide level.
"Use of 'pre-diabetes' is discouraged to avoid any stigma associated with the word diabetes and the fact that many people do not progress to diabetes as the term implies," the World Health Organization says.
Effects on individuals may include difficulties with insurance, emotional distress, social stigma and the effects of unnecessary medical treatment. For society, the primary effect is borne through increased unnecessary healthcare spending.
The researchers also note that the ADA definition does not account for ethnic differences in normal hemoglobin A1c levels, which may partially explain the high rate of "prediabetes" in China.
"We need to stop looking at this as a clinical problem with pharmaceutical solutions and focus on improving public health," Yudkin said. "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."
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