Forums » Open clinical » Diabetes » Is So-Called Prediabetes a Disease Entity?
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Is So-Called Prediabetes a Disease Entity?
posted at 4/12/2012 4:31 AM GMT
on bmj.com
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Posts: 627
First: 13/4/2011 Last: 18/6/2013 |
Well, many people argue that indeed it is and should be treated with anyone of the modalities, pharmacological and non-pharmacological, measures for the prevention and treatment of type 2 diabetes. Those in favour of prediabetes as a disease entity are known as glucocentric diabetologists, or let´s say “sugar doctors”, and have even conducted a Randomised Clinical Trial (The ORIGIN Study) utilizing the synthetic Insulin from Sanofi in more than 1.000 subjects with pre-diabetes. Those who are against the definition of prediabetes as a disease entity argue that it is not true that this is a real disease entity, because we do not know for sure which person will indeed become diabetic (Fasting Plasma Glucose > 126 mg/dL or 2 hours Oral Glucose Tolerance Test > 200 mg/dL), Prediction of Risk Score Models are not yet externally validated and tend to overestimate the risk of type 2 diabetes, that the thresholds for the definition of diseases are becoming progressively lower over the years, that we would be giving drugs just to treat numbers instead of treating individuals with diseases (Overtreatments with potentials for, and real Harms), and finally, that there is no epidemiological evidence that Glycaemia levels in the range of so-called prediabetes has any cardiovascular consequences or risks. Those not in favour of treating with drugs, those with a fasting plasma glucose between 100 and 125 mg/dL are mostly known as Non-glucocentric diabetologists, or let´s say, just Non-Sugar doctors:
http://www.bmj.com/highwire/filestream/586604/field_highwire_article_pdf/0/bmj.e3018 http://care.diabetesjournals.org/content/30/2/332.full.pdf So, what do you think? All Best, Joey
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Re: Is So-Called Prediabetes a Disease Entity?
posted at 4/12/2012 8:51 AM GMT
on bmj.com
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Posts: 1343
First: 13/4/2010 Last: 19/6/2013 |
The question you have to ask yourself Joey is who stands to benefit from the creation of this new disease entity? The evidence suggests not the potential patients it would create. Therefore we are left with Big Pharma and, in those countries with private health care system, the clinicians themselves. That all strikes me as suspicious and disturbing. There was a report on my local radio yesterday that the number of type 2 diabetics had doubled in the UK from about 1 million in 1996 to over 2 million now. But that also got me wondering - is this increase all genuine? For sure some of it probably is with an ageing population and rising levels of obesity. But how many have become diabetic simply because the goal posts have been shifted? In otherwords how many are now diabetic because we have lowered the threshold for blood glucose levels at which we make the daignosis? And, more importantly, how many have been helped and how mnay have been harmed as a consequence of this? |
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Re: Is So-Called Prediabetes a Disease Entity?
posted at 4/12/2012 12:50 PM GMT
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
Prediabetes is not to be considered a disease entity. But the patients need further follow up and regular watch, as they might be prone to develop diabetes if proper preventive measures are not taken. |
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Re: Is So-Called Prediabetes a Disease Entity?
posted at 4/12/2012 9:50 PM GMT
on bmj.com
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Posts: 1
First: 4/12/2012 Last: 4/12/2012 |
Pick an indigenous community such as Nauru. In rough terms 50% of the adult population are diabetic and 30% are prediabetic. My conclusion is that there must be a strong connection between diabetes and prediabetes. If I lived on Nauru and were prediabetic I would want treatment with the hope/expectation that I could prevent progression to diabetes. Further, it is suggestive that there is a gradation between normal and diabetes and that many prediabetic's are actually diabetics in an earlier phase where our biochemical marker for disease is not adequate to diagnose Finny |
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Re: Is So-Called Prediabetes a Disease Entity?
posted at 5/12/2012 9:39 AM GMT
on bmj.com
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Posts: 627
First: 13/4/2011 Last: 18/6/2013 |
Hello Finny: This indigenous community looks very similar to the Pima Indians in Arizona, which have astonishing degrees of obesity, incidendence of type 2 diabetes and its complications! The same Pima Indians, when living in Mexico, DO NOT have ALL that of their American´s neighbours. And they are thin!!! So, It is looks like LifeStyle and envrinoment factors are playing the major roles for the presence or absense of diabetes. And it is not that easy at all dealing with these kind of issues with Drugs! All Best, Joey
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Re: Is So-Called Prediabetes a Disease Entity?
posted at 5/12/2012 11:31 AM GMT
on bmj.com
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Posts: 1828
First: 7/3/2009 Last: 18/6/2013 |
I am worried. As an epidemiologist I see how each entity that comes to light immediately becomes a hot debate involving: Is this a disease? Should it be medically treated? Who is the "devil" behind the new hype? Well, ladies and gentelmen, perhaps I will bring you back to the basics of prevention. Primary prevention means that we prevent a condition. In that sense impaired fasting glucose and impaired glucose tolerance and other names are actually entities that fall between primary and secondary prevention (that is early detection).It is a condition that leads to disease. Some of our basic science friends would argue it is already a disease. Not an illness( patient doesn't feel ill). I can discuss in length the reasons why we should take those seriously and try to do something about them. On clinical, population and molecular levels.I would say that first and foremost come dietary and lifestyle modification measures. These can help alter the course many times. I am not a great supporter of medication introduction during those stages.Only for the groups that fail to respond to lifestyle modification and with family history and those showing a progression (rising fasting glucose, HBA1C,lipids, blood pressure). The same applies to the entity we call pre- hypertension, hyperlipidemia etc. If you don't try to prevent you end up with more diabetics, CVD patients. complications of those diseases and the cry "why do we see more of this and that etc". Sitting on fence and doing nothing to prevent is waiting for trouble to come. No one would suggest to leave in a polyp in the colon to wait till it becomes cancer, so can we ignore early signs of predilection for diabetes? CVD? In my opinion, no.
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Re: Is So-Called Prediabetes a Disease Entity?
posted at 5/12/2012 1:50 PM GMT
on bmj.com
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Posts: 627
First: 13/4/2011 Last: 18/6/2013 |
Hello skyesteve: Thanks for your comments that I entirely agree with! 1. Big PHARMA will be the sole beneficiary of medicalisation of normal people. 2. Overdiagnosis, Overtreatment, and Harms for many people should rise exponentially! 3. Overprofits for Big PHARMA should also rise exponentially, with very questionable (perhaps none) public health impact on prevention of type 2 diabetes. All Best, Joey |
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Re: Is So-Called Prediabetes a Disease Entity?
posted at 6/12/2012 3:38 PM GMT
on bmj.com
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Posts: 627
First: 13/4/2011 Last: 18/6/2013 |
In Response to Re: Is So-Called Prediabetes a Disease Entity?: is over tretment with metformine without side effect for thouse whos supposed as prediabetic Posted by tagreed shukri Hello tagreed shukrI: I am aware that many doctors still prescribe Metformin, for prevention of type 2 diabetes, based namely on a New England Journal of Medicine article published 10 years ago. Reading the article we can see that the effect of Metformin was much lower than LifeStyle Modification! If we also realize that the incidence of type 2 diabetes, on an individual basis, is still uncertain even for high risk subjects; then I would friendly argue with you: It is not much more effective and simpler, proposing and implementing Healthy LifeStyles for everybody? And, Yes every drug have side effects. Fortunately, it is uncommon serious side-effects with Metformin, beyond GI intolerance and a trend toward Vit. B12 deficiency after some period of time using it. Thanks for your question, All Best, Joey |
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Re: Is So-Called Prediabetes a Disease Entity?
posted at 7/12/2012 5:57 PM GMT
on bmj.com
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Posts: 461
First: 29/4/2011 Last: 31/5/2013 |
At the risk of beating a dead horse, I must come to the defense of prediabetes (or better pre-diabetes) since Phil Gorden, then Director of the NIDDK, and I, then Chair of the US National Diabetes Education Program or NDEP, originated the term to facilitate communication with the non-expert medical community that there was a population that could be easily identified that was at risk for the development of diabetes. Based upon their constellation of risk factors the rate of development of diabetes is between 5-11%/year. This term was coined to help physicians understand the implications of the Diabetes Prevention Program or DPP. As our epidemiologist friend yoram chaiter has pointed out the prefix "pre" has a long and distinguished career in medical terminology. Neither Dr. Gorden nor I have worked for “big PHARMA” or little PHARMA for that matter. Moving to the issue of drug treatment of pre-diabetes versus life style modification, I am unaware of any clinical guideline that suggests that any drug should take precedent over life style, which is twice as beneficial as metformin, for example. Since metformin is off patent and as cheap as dirt, many physicians are using it in pre-diabetes either with life style modification or after failure thereof. Once data developed that the treatment of pre-diabetes with metformin had a positive effect, several pharmaceutical companies initiated studies demonstrating that their drug also could be used to prevent the conversion from pre-diabetes to frank diabetes. I would argue that this was their fiduciary duty to their stockholders. But it is not our duty to recommend their use in pre-diabetes and as stated above I am unaware of professional clinical guideline that recommends that we do so. There, of course, is another problem with anti-diabetic agents in pre-diabetes. Since they lower glucose, we do not know if they are preventing conversion from pre-diabetes to diabetes or just masking that conversion. So I end my rant by stating the following: there is such an entity as pre-diabetes; it is a risk classification not a disease. Conversion from pre-diabetes to diabetes can be best reduced by life style changes, although metformin would be a second line choice should that fail. The use of any other anti-diabetic agent to prevent the conversion from pre-diabetes to diabetes should still be considered experimental and is not currently recommended by professional guidelines.
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Forums » Open clinical » Diabetes » Is So-Called Prediabetes a Disease Entity?
