IDDT’s Position Statement – ‘pre-diabetes’

InDependent Diabetes Trust, August 2014

The term ‘pre-diabetes’ has crept into our language and there is debate about its use.  People who are at risk of developing Type 2 diabetes are now being classed as having ‘pre-diabetes’ or ‘borderline diabetes’. In 2010 the American Diabetes Association expanded the diagnostic categories to include a definition of ‘pre-diabetes’ as being when blood glucose levels are on the high side of normal but not high enough to be classed as diabetes.

Pre-diabetes is being ‘diagnosed’ if test results are as follows:

  • Fasting glucose levels of 5.5 mmol/l to 6.9 mmol/l
  • HbA1c levels of 42 to 47 mmol/mol (between 6 and 6.5%).

This definition has resulted in a third of adults in England fitting into the category of having ‘pre-diabetes’. According to Diabetes UK, 18 million people in the UK fall into this category. (Diabetes UK press release 16.07.14) The situation is similar in many other countries such as China where 50% of adults could be classed as having ‘pre-diabetes’.

This group of people have no symptoms of ill health but they are being labelled as having a medical condition of ‘pre-diabetes’. This in itself brings with it a new set of problems including anxiety about future health problems (which may never occur), issues associated with self-image, insurance and employment.

Professor John Yudkin of University College London, has stated that for ‘pre-diabetes’, the risk of developing diabetes is probably 10%-20% over 10 years and that "pre-diabetes is an artificial category with virtually zero clinical relevance".

Professor Yudkin and colleagues at the Mayo Clinic in Minnesota, writing in the British Medical Journal, also stated that current definitions of ‘pre-diabetes’ risked unnecessary medicalisation and created unsustainable burdens for healthcare systems.

They also said:

  • no studies have examined the effect of lifestyle or drug interventions in these newly added subcategories
  • there is no evidence of benefit from treating people in these categories with diabetes drugs before they develop diabetes, especially as many of them would not go on to develop diabetes.

(BMJ 2014; 349 doi: Published 15 July 2014)

The term ’pre-diabetes’ is not recognised by the World Health Organisation and the National Institute for Health and Care Excellence (NICE) has stated to BBC News that it does not believe there should be a separate category of ‘pre-diabetes’.

There have always been people who are at risk of developing Type 2 diabetes and those at risk have been advised to change their lifestyle – a healthy diet and plenty of exercise, which can either slow down or prevent the development to Type 2 diabetes. They have been diagnosed as having:

  • impaired fasting glucose, when blood glucose levels are higher than normal after fasting
  • impaired glucose tolerance, when blood sugars are higher than normal sugar levels after eating.

The Position of the InDependent Diabetes Trust

  • ‘Pre-diabetes’ is not a medical condition and using this term can do more harm than good.
  • Some people are at risk of developing Type 2 diabetes and lifestyle interventions have been shown to be beneficial in slowing down or preventing the development of Type 2 diabetes but there is no such evidence for the wider group of people now being classed as having ‘pre-diabetes’.
  • There is no evidence that treating this newly widened group of people with diabetes drugs has any beneficial effects or will improve mortality and morbidity.
  • The increase in overweight and obese people, and therefore the increased risk of Type 2 diabetes, is a public health issue and the development of effective public health interventions should be treated as a matter of urgency.
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