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
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.
The 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%
|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.
Dr. 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.