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Half of Americans have diabetes or pre-diabetes? Really? What does that mean?

Headlines and stories across the US are blaring the apparently frightening news:

The Los Angeles Times: Diabetes nation? Half of Americans have diabetes or pre-diabetes

WebMD skips the pre-diabetes discussion and jumps right in with: Diabetes a Concern for Half of Americans

NBC News: Half of Americans Have Diabetes or High Blood Sugar

This is all based on a study published in the Journal of the American Medical Association this week.

I couldn’t find a single story that questioned those numbers or the definition – the expanding definition of diabetes and its newer-named little sister, pre-diabetes.

a1c-graph-216x241The American Diabetes Association offers this chart to show the definition of diabetes and of pre diabetes, based on hemoglobin A1c, a measure of blood glucose over 2-3 months’ time. The ADA – and others – now accept this as gospel:

Diabetes is diagnosed at an A1C of greater than or equal to 6.5%

Result A1C
Normal less than 5.7%
Prediabetes 5.7% to 6.4%
 Diabetes 6.5% or higher

 

Not everyone accepts the claim that half of all Americans have either diabetes or pre-diabetes, primarily because not everyone accepts the rigid boundaries and the lower boundaries that now start labeling you as pre-diabetic if your hemoglobin A1C test comes back at 5.7% or higher.

MontoriDr. Victor Montori is a diabetes specialist at the Mayo Clinic.  He’s an endocrinologist and a researcher who actively promotes shared decision-making between doctors and patients.  I talked with him by phone today about the new study, the news coverage, and the definition of pre-diabetes.

Click on the arrow, below, to hear a portion of that interview.

 

So do we know that half of Americans have diabetes or pre-diabetes?

Only if you accept the lower threshold for what we define as these conditions.

But I haven’t seen a single news story that raised the kinds of questions that Dr. Montori raises.  Not even the editorial addressing the study in JAMA addressed these concerns.

Tomorrow, I’ll have more on this topic, as I introduce a new podcast with Dr. John S. Yudkin of London, with whom Montori has co-authored such pieces as:

Please come back to hear that interview tomorrow.

 

Addendum:  John Fauber and colleagues of the Milwaukee Journal Sentinel  and MedPage Today reported on similar issues back in December of 2014.  With permission, I’m re-posting a key chart from that story, below.

Courtesy: Milwaukee Journal Sentinel & MedPage Today

Courtesy: Milwaukee Journal Sentinel & MedPage Today

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Comments (6)

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Flem

September 10, 2015 at 2:55 pm

Frankly this is confusing. I would prefer they differentiate between A1C levels when it contributes to actual disease vs as a risk factor. Much the same way we think of treating CV disease by managing cholesterol after you’ve had a prove event (MI or stroke). You should not be labeled as having the “disease” Diabetes until you’ve shown pathology (eye,kidney,nerve damage) regardless of your A1C.
Would you rather have an A1C of 6.5 and no signs of pathology vs 5.2 with nephropathy and retinopathy? Who would you treat? Who needs management of their blood sugars more?”

Harley

September 10, 2015 at 11:58 pm

This kind of stuff dilutes perceptions of how serious diabetes is and results, as Dr Montori points out, in scarce resources being wasted and misdirected.

I’ll look forward to hearing the podcast.

Beverly

September 14, 2015 at 10:47 am

It would be interesting to know the relationships between the “experts” promulgating the increasingly inclusive definitions of diabetes and prediabetes and the more aggressive treatment thereof and the manufacturers of the anti-diabetes drugs.

John Anthony

September 14, 2015 at 6:33 pm

re Beverly. Yes indeed, This all smells like the cholesterol and statin story, all driven by big Pharma, with lower and lower levels of cholesterol being considered to be safe.

Laurence Alter

September 17, 2015 at 5:31 am

If all the world were to follow a standard diabetes diet and the DASH diet – regardless of personal health status – you’d see a dramatic lowering of disease. The second truth: people are FAR more complacent about their health than worried (Dr. Oz says that men are “notoriously negligent” about check-ups; so are my female friends: they wouldn’t know a thyroid gland if it bit them in the nose). If over-diagnosis wakes people up, FINE. A few of the comments below assume drugs and Big Pharma are part of a treatment program. Nothing suggests this from the two audio recordings linked to the above article. If you doubt the complacency of the general public or general practitioners in medicine, see what happens at the dentist’s office: the dentist or hygienist (sp.?) is in your mouth for fully half an hour and in silence. No information is forthcoming. You could be learning ALOT about dental care and prevention in that ‘Wasted Time of Silence.’ This applies to other specialties, too.
Yours,
Laurence