Monday, 30 October 2017

Prediabetes epidemic in sight

Prediabetes is a terminology that, recently, is used when a person is detected with higher than normal levels of blood glucose, but there is no pathology. Prediabetes could be understood as a disposition to develop diabetes in the future, a disease that, in turn, represents a condition that puts one at risk of serious affections such as nephropathy, retinopathy or cardiovascular disorders, among others. Due to this chain of risks, and with a healthy intention to reduce morbidity and mortality, the American Diabetes Association (ADA) led a study to consider that glycosylated haemoglobin (HbA1c) is a test that can be done without any preparation or need for fasting and see if it can become a new criterion for detecting prediabetes. The concern arises when, according to this diagnostic extension, it’s estimated that in millions of pre-diabetics would show up: in China 493, in the US 86 and in Spain 6, to cite three countries from which I have data.

Based on the "sooner rather than later" motto, ADA, with the collaboration of other US private and public organizations, has launched a campaign to detect as many pre-diabetics as possible, and then advise them to go to their doctor to see what it should be done.

At the doors of a new epidemic, many experts question whether pre-diabetes should even be the subject of a health action of the scale that is being prepared in the United States. John Yudkin and Victor Montori, in an article in the British Medical Journal, say they are concerned that the scale of this epidemic will collapse health systems and will send millions of people to unnecessary treatment.

According to Yudkin, prediabetes is an artificial category with no clinical relevance when, he says, there is nothing to prove that if these new prepatients are treated they can be prevented developing the disease. In this sense, the Spanish Society of Diabetes (SED) takes the same view, although in a more moderate way. In a consensus report, in spite of advising the detection of prediabetics, SED admits that once the cases are discovered, medical actions should be limited to modifying lifestyles, given that drugs, such as metformin, are not an efficient option.

Victor Montori goes further when he argues that, if we really want to do something to prevent obesity and diabetes, instead of pursuing suspicious cases, it would be much smarter to propose policies that would reduce the causal factors of the epidemic from a cultural, nutritional and social and economic education perspective. Montori makes his position clear in an interview where he explains that when he stated that he should not medicalize prediabetics, he did not mean that they should not be given medication, which is obvious to him, but, in his opinion, that groups with risk factors for developing diabetes should be sent to the gym and to the greengrocer's shop, instead of cataloguing them and filling them with saturated medical consultations.

Jordi Varela

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