Prediabetes. Is this diagnosis important? Helpful? Harmful?

Prediabetes.  Is this diagnosis important? Helpful? Harmful?

Before 2004, hyperglycemia (elevated blood sugars) was not considered significant.  The American Diabetes Association began in 2004 labeling elevated blood sugars of prediabetes to increase awareness and prompt physicians and patients to act. 

What constitutes a diagnosis of prediabetes? Fasting blood sugars between 110 and 125 or a hemoglobin A1c between 6-6.4%.  In 2010 the ADA lowered these thresholds to fasting blood sugar of 100 to 125 and A1c between 5.7 to 6.4$.  In 2017 an estimated 352 million adults had prediabetes or 7.3% of the world’s population. 

What is the rate of progression from prediabetes to diabetes?  Rate of conversion of 5 to 10% within one year, 25% within 4 years, and 70% of those with prediabetes diagnosis convert to diabetes. 

Treatment:  The question is DO we need to treat?  One review showed that to prevent one case of prediabetes from turning into diabetes within 3 years, 7 people need to participate in intensive lifestyle modification with weight loss and exercising.  There is a great cost of prolonged weight loss coaching.  The use of metformin prescription reduces the conversion to diabetes (but studies show that 14 prediabetics need to take metformin to avoid one patient from converting to diabetes).

Is there a harm of a diagnosis of prediabetes?  Prediabetes may be considered a diagnosis of questionable clinical significance.  Due to this the diagnosis could cause psychological distress and lead to additional testing, increased physician visits, and overtreatment. 

What to do?  Eat a healthy diet rich in vegetables, fruits, and lean meats. Do moderate exercise 30 minutes most days of the week.  Don’t smoke.  Maintain a normal weight meaning BMI between 20-25.

About drlesliegreenberg

I have been practicing as a family physician for over 20 years--as both an educator of physicians and clinician. From infancy to the elderly, I perform obstetrics and general medicine. I love my career and am passionate about my field of knowledge and my patients. Follow me on Facebook at Leslie Md Greenberg Medical Disclaimer The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.
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