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Prediabetes: Time to Call a Spade a Spade

Guest Editorial

We are always glad to hear from our readers and recently we received this response from Alan S. Kaplan, M.D., to our March 4th Diabetes Clinical Mastery Series, Issue #178, in which we included two presentations focusing on prediabetes. We thought it was well worth sharing Dr. Kaplan’s perspective.

Alan-S-Kaplan

” ‘Prediabetes’ is a condition that occurs when a person’s fasting blood glucose levels are higher than normal (100 or greater) but not high enough for a diabetes (type 2) diagnosis. Prediabetes is becoming more common in the United States. The U.S. Department of Health and Human Services estimates that about one in four U.S. adults aged 20 years or older — or 57 million people — had prediabetes in 2007. Those with prediabetes are likely to develop type 2 diabetes within 10 years, unless they take steps to prevent or delay the diagnosis of diabetes.”1

The time has come to drop “prediabetes” from our vocabulary and call a spade a spade. It’s diabetes.

In the past 20 years or so we have come a long way in our understanding of type 2 diabetes. We know that, unlike a fracture, a heart attack or a stroke, diabetes doesn’t have a defined starting date. At present it is a gradual progression until the patient’s A1c reaches 6.5 or higher. At that point we say the person is a diabetic. Yet the person has been a diabetic for years before. So why must we wait, knowing what we know about the development of devastating complications?

Complications are the real concern about diabetes. This is especially true as our population ages. Thus it is time to drop “prediabetes” from our vocabulary and call a spade a spade. When a person has persistent fasting blood sugars over 100, let’s diagnose diabetes and begin management to prevent complications – which is the real aim of treatment. Why must we wait for the magic 6.5?

Now that the Affordable Care Act has made pre-existing conditions a thing of the past, we should not be afraid of calling someone with elevated blood sugars over 100 but less than 126, a diabetic. We should not be afraid to call someone a diabetic with an A1c less than 6.5. We know that the longer the duration of diabetes (≥10 years) the more there is an increased risk of devastating diabetic complications. It doesn’t matter what the fasting blood sugar is, it matters how long blood sugars stay over 140.2 When we begin diabetic management early, we hopefully get better control of elevated blood sugars. We know that diabetic complications become more likely with increasing age and that our diabetic population is living longer.3

In conclusion, it is now time to remove “prediabetes” from our vocabulary and begin treating diabetes when we first note the elevated blood sugars to prevent diabetic complications especially as our population ages and to better manage patients.

References:

  1. National Diabetes Clearing House web site 4/2014
  2. Can Fam Physician 55,No. 4,Apr 2009,pp.363-369
  3. JAMA Intern Med. 2014;174(2):251-258.