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Dr. Richard Lehman: Why does having abnormal glucose tests cost the USA $245bn?

richard_lehmanDr. Richard Lehman’s journal review blog for The BMJ is one of my favorite weekly reads.

Today he comments on last week’s study that led to all of the news coverage claiming that half of all Americans have diabetes or pre-diabetes.

He wrote:

Now when I read most of the literature about diabetes I feel as if I’m trapped in revival meeting of a religion that I don’t belong to. Why does having abnormal glucose tests cost the USA $245bn? Does everybody beyond these threshold values pose an inevitable burden on the US economy? Wouldn’t it be better to do fewer of these tests and so reduce costs and spare a lot of people from needless anxiety and futile treatment? I turned in vain to the editorial on this study, with the alluring title “Prevalence of Diabetes in the United States: A Glimmer of Hope?”

It begins: “Obesity is a major risk factor for type 2 diabetes” and goes on to point out that between 1980 and 2000 the prevalence of obesity in the USA doubled, but since then seems to have reached a plateau with 35% of US adults aged 20 years or older estimated to be obese. And the prevalence of diabetes seems to have actually decreased a bit since 2008, despite a higher level of detection. The American Medical Association, the author notes with approval, has classed obesity as a disease. Well, anything for a crazy society to change its habits I suppose. Maybe it would help if the AMA classed gun ownership as a disease. I feel disoriented in a strange world of category errors and reversed logic. Somebody please help me. Just what is this “type 2 diabetes”?

MontoriWe published an audio interview with Dr. Victor Montori of the Mayo Clinic about that study.

Dr. John S. YudkinAnd we also published a related podcast with Dr. John S. Yudkin of University College, London, about pre-diabetes and “the idolatry of the surrogate.”

If you’re interested, here’s more on that estimate of $245 billion per year for the total costs of diagnosed diabetes in the US.

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Comments (1)

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Tazia K. Stagg

September 14, 2015 at 1:08 pm

Dr. Lehman, would it be better to do fewer of these tests?