Predictable Pre-diabetes One-sidedness

A new campaign to increase awareness about pre-diabetes has exploded in news coverage today.  This post is about news coverage and journalistic responsibility – so please don’t misconstrue the message that follows. Diabetes is a serious public health concern. But there are things journalists could have – arguably should have – included in their stories about this ad campaign.  But most played matador.  They waved the cape and let the unvetted awareness message go by without questioning.

Little awareness has been raised in most news stories that there are other views – more skeptical views – about raising awareness about pre-diabetes.

First, background.  It’s a campaign launched by the American Diabetes Association, the American Medical Association, the Centers for Disease Control and Prevention, and the Ad Council.

On Medscape, Dr. Ann Albright of the Centers for Disease Control and Prevention (CDC) appears in a video, explaining:

As you know, prediabetes is a treatable health condition characterized by blood glucose levels that are abnormally elevated but are not high enough yet to be classified as type 2 diabetes. Prediabetes increases the risk for type 2 diabetes, heart disease, and stroke. The facts are clear:

  • 86 million people in the United States have prediabetes—and 9 out of 10 of them do not know they have it.
  • Recent studies suggest that 1 out of 3 people over the age of 18, and half of people over age 65, have prediabetes.
  • Without lifestyle changes to improve their health, 15%-30% of people with prediabetes will develop type 2 diabetes within 5 years.[1]

The good news is that there is an effective treatment that can prevent or delay type 2 diabetes in those at high risk. That treatment is a structured lifestyle program that provides real-life support for healthful eating, increasing physical activity, and enhancing problem-solving skills. The growing confirmation that evidence-based lifestyle interventions are effective in reducing cardiometabolic risk is encouraging and motivating.

News coverage is off the charts.  A couple of examples:

CBS:  New campaign urges millions to check for pre diabetes.

My note:  There isn’t any discussion of alternative viewpoints.  Except in the reader comments left online, which include these:

– “since I’ve gotten old my doctor tells me about all the pre stuff I may be suffering from, as far as I’m concerned I’m suffering from predeath.”

– “If you do not have diabeties, then you ARE PRE-DIABETIC. Get it!  Just another way of adding more numbers to the already manipulated totals.”

Do you see what can happen when you constantly bombard people with awareness campaigns?  They become numb. They developed jaundiced views.  (Note: I am not raising numbness and jaundice as new pre-disease concerns!)

WebMD, posting a HealthDay story, reports: “No one is excused from diabetes.”  Really?  No one?  That statement goes unchallenged in the story.

There are other perspectives worth considering.  I turned to two international experts on the topic, who have written about overdiagnosis concerns in diabetes in the past.

Mayo Clinic diabetes specialist Dr. Victor Montori wrote to me:

“I thought people could not get enough time with their doctors and that we have huge disparities in access and quality of care for people with diabetes. Why then add a large demand for primary care for a condition that requires societal action rather than clinical care from the same professionals and offices that are overwhelmed?”

Dr. John S. Yudkin, emeritus professor of medicine at University College in London wrote to me that he’s actually working on a presentation on prediabetes as an example of “corporate capture” at the London School of Hygiene next week.  He’s analyzing a “pre diabetes management app” for a program that costs $130 per month for the first 4 months.  He wrote:

“It included a test to see if I was at risk. I entered my age, BMI (22.5) and exercise profile (2h per week at gym), and the result was that the CDC said I was at high risk because I was over 65.”

He also sent me a Lancet paper reporting that the Diabetes Prevention Program Research Group, in 15 years followup, “showed no impact of either lifestyle or metformin on the development of the diabetes-specific, microvascular, complications.”

For more on the kind of perspective not present in today’s news coverage, see our past posts on this topic, with Montori and Yudkin:

Dr. Yoni Freedhoff, one of our reviewers, gave me this balanced perspective:

“On the one hand, no doubt there are plenty of people out there with actual diabetes who don’t know it yet, and if this campaign leads them to that discovery, treatment may well improve their quality and quantity of life. On the other hand, are we further medicalizing normal and might that not carry some risks of its own?”

Drs. Steve Woloshin and Lisa Schwartz of Dartmouth Medical School wrote me:

“We are concerned about campaigns like this which try to promote health by making people sick.  Giving people a diagnosis has lots of emotional consequences – we should only do it when there is evidence that the benefits outweigh the harms.  This is certainly not the case with prediabetes.   The main treatment for borderline high blood sugar is diet and exercise.  We can promote diet and exercise without turning one third of the US population into patients unnecessarily, making them needlessly anxious and perhaps subjecting them to more medical treatments that might not help (or even harm) them.”

Yes, the ad awareness campaign is cute, clever, compelling.  And incomplete, as most ad campaigns are.  Journalists have a responsibility to do more than report based on PR news releases or ad campaigns.  Most didn’t do it on this story. When you’re reporting on “millions” being urged to check for prediabetes, think about what that means.  Millions should do what?  See their doctor and become labeled?  Those are big issues, huge societal issues as Montori consistently points out.

Maybe there should be another independent perspective in your story before you just post the cutesy ad video.

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Comments (7)

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Pat

January 22, 2016 at 5:01 pm

Thank you for this post.
My blood glucose has not changed much since it was first measured back in the stone age; back then it was deemed completely normal, but now it’s labeled pre-diabetes. My question is, if I’ve had ‘pre-diabetes’ for 40+ years without developing diabetes, what the heck does the ‘pre-‘ mean?

Tina

January 22, 2016 at 5:31 pm

Glad there are doctors out there aware of the potential harms that can come from needlessly medicalizing “normal”. I’ve read papers that say many with prediabetes never go on to develop diabetes, so as a predictive measure it’s very questionable. Just live a healthy lifestyle.

    Tom

    January 22, 2016 at 10:52 pm

    I have pre-diabetes and I wish I had known earlier as I would have avoided carbs and exercised more (as I am now). Also, strong studies prove that even having “pre-diabetes” doubles cardiovascular disease risk. So it’s important for people to learn and have a chance to attempt to mitigate.

      Gary Schwitzer

      January 23, 2016 at 6:35 am

      Tom,

      Thanks for your note.

      Please provide the “strong studies” so they can be scrutinized.

Cynthia Miller MD

January 23, 2016 at 4:13 pm

In the spirit of full disclosure, I am a trained lifestyle coach for the Diabetes Prevention program. I began volunteering for the program because, as a physician, I became very frustrated by the lack of time and resources available to me for counseling patients about nutrition and physical activity. Unhealthy lifestyle habits lead to more than just diabetes but also hypertension, heart disease and even liver failure from fatty liver. The Diabetes Prevention Program is a great way to reduce these diseases and our future health care costs by providing an evidence-based low cost intervention. If people who are “healthy” are labeled pre-diabetic and that is considered unjust, then maybe we need to discuss people’s perception of health. In addition we focus so much on high cost care and very little on prevention. It’s about time that we spent some time thinking about it.

Gary Schwitzer

January 25, 2016 at 6:33 am

Dr. John S. Yudkin of London, quoted in the article above, followed up with me via email with an additional perspective:

“The other thing about Ann Albright and the CDC is that they are scaremongering. What they’ve done is to use the rate of development of diabetes during the Diabetes Prevention Program – around 30% over 5 years in the placebo group. But these were overweight or obese people with both impaired glucose tolerance and elevated fasting glucose. Such people represent around 8%-10% of American adults, around 20 million rather than 86 million with the diagnosis of ‘Prediabetes’ by the expansion of the definition (‘Overdiagnosis’). So, as around 1.7 million people get diabetes each year, assuming that these people all deteriorated from ‘prediabetes,’ the rate of diabetes development is around 2% per year, or maybe 9 million over 5 years.

Lots, but a third of the CDC figure.”

Steven Kussin MD

January 26, 2016 at 7:55 am

The pre-this ,per-that nonsense can be summarized by author Jonosyhsn Tropper

Health, is just the slowest possible rate at which one can die.