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USA Today story shows lack of awareness of debate over pre-diabetes classification

USA Today published a story, “Pre-diabetes, diabetes rates fuel national health crisis.

But the story fails to note one word of caution or skepticism about the definition of pre-diabetes.  Just two months ago, Victor Montori of the Mayo Clinic and John Yudkin of University College London wrote in The BMJ, “The epidemic of pre-diabetes:  the medicine and the politics.”  And it wouldn’t require much effort to find much more evidence of the controversy over pre-diabetes.

How could this happen?

The USA Today story uses an American Diabetes Association spokesman as a key source.  He is quoted saying:

“We’ve proven (pre-diabetes) is an intervention time,” said Matthew Petersen, the association’s managing director of medical information and professional engagement. “It’s a call to action.”

The BMJ analysis – part of a series called “Too Much Medicine” that looks at “the risks and harms to patients of expanding definitions of disease and increasing use of new diagnostic technologies” – criticizes American Diabetes Association classification of pre-diabetes. Excerpt:

“Aldous Huxley wrote that “Medical science has made such tremendous progress that there is hardly a healthy human left.” Changes to the American Diabetes Association (ADA) guidance on the diagnosis of pre-diabetes in 2010 make this statement even more true. If implemented globally the guidance could create a potential epidemic, with over half of Chinese adults, for example, having pre-diabetes, a national burden of around 493 million people.”

By not including an independent perspective – or any acknowledgement about the ongoing debate over classification of pre-diabetes –  the USA Today story was woefully incomplete.

There’s an entirely different tone in the news story than in The BMJ article.

The USA Today story states: “Doctors and experts coined the name pre-diabetes in the late 1990s, replacing less worrisome terms such as “borderline diabetes” that didn’t convey the seriousness of the condition….As pre-diabetes rises, experts are pushing for greater awareness and screening.”   So the story conveys a message that more worry should be generated.

But the expert analysis in The BMJ advises doctors to tell patients: “A diagnosis of pre-diabetes does not mean that you will develop diabetes. In fact, of 100 people like you, fewer than 50 are likely to develop diabetes in the next 10 years.”  And it has an entire section on “Harms and risks of overdiagnosis.”  Excerpt of that section:

“There is a hazard in creating a pre-disease associated with a disease such as type 2 diabetes, which is itself little more than a risk factor. The biochemical diagnosis of type 2 diabetes is based on a surrogate endpoint. The downsides of being diagnosed with diabetes include the need for medical care and treatment, with its costs and risks, challenges with insurance and employment, anxiety about future complications, and self image. Pre-diabetes could be defined as a risk factor for developing a risk factor. With this label comes much of the same baggage as for diabetes, without evidence of long term benefit.”

We hope that USA Today – and readers – can see what a difference independent perspectives and a broader literature search can make in the framing of a story.

Either the journalists involved knew about the controversies and chose not to acknowledge them, or they were unaware of the controversies.  Either is bad – and easily fixed.

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