Prediabetes is a Non-Disease
In 2001, the American Diabetes Association (ADA) relabeled impaired fasting glucose and impaired glucose tolerance as prediabetes in an attempt to convince physicians that a slight increase in fasting blood glucose is a risk factor for type 2 diabetes. ADA and the Centers for Disease Control and Prevention (CDC) then declared prediabetes a national health emergency. ADA’s current definition of prediabetes is based on a hemoglobin A1c level between 5.7% and 6.1%. This new definition created about 72 million new prediabetes patients in the United States alone.
The wider definition of prediabetes has greatly increased medical spending on physician visits, diets, supplements, fitness coaches, lab tests, glucose self-monitoring and medications. In 2007, ADA began recommending metformin for treatment of patients with prediabetes and other risk factors such as obesity. Since 2013, ADA standards of care have increased the number of drugs to treat prediabetes to include pioglitazone (Actos), exenatide (Bydureon), and liraglutide (Victoza). All of these drugs have black box warnings of serious adverse effects.
Interestingly, the World Health Organization (WHO) rejected prediabetes as a disease category because it was not convinced that prediabetes led to diabetes or that treatment benefits would outweigh risks. CDC’s own data demonstrated that only 2% of patients with prediabetes progressed to diabetes each year. A comprehensive Cochrane review in 2018 stated that most prediabetic patients never progress to diabetes over any time interval studied. This review also reported that up to 59% of prediabetic patients returned to normoglycemia over 1 to 11 years with no treatment.
Ethicists criticize the ADA from accepting $18 to $27 million per year from diabetes drug companies. The American College of Physicians rated ADAs prediabetes and diabetes guidelines as having an extreme level of financial conflicts of interest with drug companies. Seven of the 14 ADA individuals on the expert panel received between $41,000 and $6.8 million between 2013 and 2017 from diabetes drug companies.
ADA’s expanded definition of prediabetes has clearly been a financial boondoggle for the ADA, physicians, clinical laboratories, drug companies, and device makers. The losers have been the millions of people who have been diagnosed with an apparent non-disease.
Reference
Piller, C. Dubious Diagnosis. Science 2019;363:1026-31.
