Bit of a feisty reply to izzy, calm down
You are, however, right. "Between 5% and 10% of people with prediabetes go on to develop Type 2 diabetes each year" (link to source below), izzy's OH must be in the unlucky 5 - 10%.
I effectively "control" (as she can't) everything my wife eats if I don't buy it then she doesn't get to eat it, when she asks for sweet things I just tell her we're out of them but I'll put it on the shopping list and never do. I guess it's harder if you have a sweet tooth too, me I can't remember the last time I ate a biscuit or chocolate maybe that's why I got taken off statins at my last annual check up.
K
https://www.diabetes.org.uk/About_us/News/Prediabetes-whats-it-all-about/
You stirrer, Kevin!
I wasn't being 'feisty' just stating a fact.
There was an interesting, informative item about pre-diabetes test on 'Health Matters' Radio Four 28/7/15 starts at about 5 minutes in.
http://www.bbc.co.uk/programmes/b0639w4c
Transcript
Porter
Now a new variant of diabetes – well, sort of. Pre-diabetes is already well established in America and now the label has arrived here and could be applied to as many as 11 million adults across the UK.
Using one of three measures – a person’s fasting blood glucose level; how they react to drinking a sugary drink; or an HBA1c test that gives an idea of glucose levels over weeks – it is possible to identify people with borderline normal readings. And it’s this grey area between diabetes and normal that is being called pre-diabetes, with research suggesting that as many as 1 in 10 people so labelled will go on to develop full blown Type 2 within a year.
But the new label remains controversial, not least because opinion differs as to what is normal and what’s not, and how you test for it. Edwin Gale is Emeritus Professor of Diabetic Medicine at the University of Bristol.
Gale
To explain the story of pre-diabetes I should first of all say that everyone’s blood glucose tends to rise as you get older. Now there are three ways of defining a blood glucose. So one of the problems with pre-diabetes is that there are three doors in, there aren’t actually any doors out, there is no official way I’ve discovered of being undiagnosed with pre-diabetes. Now if all three measures correlated 100% there would be no problem but in fact they overlap very weakly. For example, fasting blood glucose overlaps by only about 30% with the definition of diabetes in terms of a glucose tolerance test. So the result of having this very wide net is that you’re catching an awful lot of fish and you’re not necessarily catching the people you want to catch.
Porter
So it’s quite possible to get two different results, you could be told you have pre-diabetes on one and be told you’re perfectly alright on another?
Gale
Absolutely, in fact quite a few people who terms in HPA1c have pre-diabetes don’t on strict glucose criteria, so you’re going into a semantic circle as to what exactly you’ve got.
Porter
We’re picking a lot of people up with pre- so-called pre-diabetes.
Gale
Well of course you are, I can speak to that personally because I’m 70 so I guess I class as elderly and I also have pre-diabetes in terms of a mildly elevated blood glucose. But so do most people over the age of 80, in fact over the age of 80 74% of women and 55% of men have diabetes or pre-diabetes, so it’s a normal ageing phenomenon. And we’re left with a question of what’s disease, what is normal ageing process. If you put that label upon someone what evidence have you got that you can actually help them?
Porter
Well that’s my next question. So if somebody’s coming in who is 78 and otherwise fit and well and is found to have sugar levels in this borderline range and have pre-diabetes I can see the diagnosis might not be – putting a label on might not be that useful. But if they’re 40 and they’re six stone overweight, they’re a smoker and they’ve got lots of other risk factors it might just be useful in terms of galvanising some action, both on behalf of the doctor and the patient.
Gale
Well here you come absolutely to the nub of the issue. Telling someone they’ve got a blood glucose that’s high at the age of 30 is actually something that makes a huge difference to their life and which they can do a lot about. But there’s in fact no evidence at all that in the elderly person, as against the young person, that that intervention will be helpful.
Porter
So pre-diabetes may not be useful at the age of 90, at one end of the spectrum, it probably is very useful in your mid-20s, it’s the grey area in between which is actually where a lot of these people are being picked up, so it’s middle age and older.
Gale
I think my grouse there is that we have a diagnosis and a guideline based on a one size fits all number, it’s ludicrous to give a single number to every member of the population. And I think that’s the entire problem.
Porter
Well listening to that in the studio with me is Simon O’Neill who’s director of health intelligence at Diabetes UK and Dr Margaret McCartney is in our Glasgow studio.
First of all Simon, what do you think of the term pre-diabetes?
O’Neill
Diabetes UK doesn’t really like it and when we’ve spoken to people who are at risk of diabetes the problem is they seem to think that means they’re diagnosed with diabetes, they’re just diagnosed a bit earlier and it’s sort of inevitable that they’ll go on to develop diabetes. And of course that’s not the case, only 5-10% of people who would fall into a pre-diabetic range will actually develop Type 2 diabetes in the following year. We wonder that therefore that actually makes them think because it’s inevitable I might as well just not do anything and let it happen. However, I think there is a really important thing that people in this early stage where their blood glucoses aren’t quite working properly – if they’re overweight, if they’re not very active – they can do something to actually reduce that risk. Therefore we prefer the term to be at high risk of Type 2 diabetes.
Porter
Margaret, do you use the term pre-diabetes in your consulting room?
McCartney
No I don’t and I have to say I’m very suspicious of the medical industry’s desire to start categorising more people with having pre- something. We’ve seen it with pre-dementia, we’ve seen it with pre-hypertension and this, I think, is yet another instance of criteria being brought down, more people being caught in the net and the question is how many of those people will benefit from an earlier diagnosis of something that may never happen to them.
Porter
Simon, let’s pick up on Prof Gale’s concerns. Firstly the cut offs – are you confident that we’ve got the cut offs in the right place? Looking on the Diabetes UK website I mean they talk about a fasting plasma glucose 5.5 -7 means that you’ve got pre-diabetes.
O’Neill
Yeah I mean I think this is a really good question Mark. There are lots of different people saying different things and that’s where the confusion lies. So we talk in the UK about an HPA1c, that long term blood glucose, being over 6, in the States they talk about being over 5.7. If you look at the population of the UK at 5.7 that’s puts eleven and a half million people at high risk.
Porter
As do those criteria that I mentioned for the fasting. So one in three adults…
O’Neill
Whereas if you move it to 6, which doesn’t seem a big move, that drops it down to four and a half million people. And I think it’s really – actually working out who is going to best benefit from being told they’re at high risk of diabetes and who is actually going to best be able to do something to prevent that happening and prevent the long term complications.
Porter
So what’s being done about that because I know that you’re involved in the Type 2 prevention programme, a national programme?
O’Neill
We will be defining at criteria that works in terms of meeting the highest risk patients who are most likely to benefit. So it will be a slightly different cut off point I’m sure than ones we’ve had before but hopefully it will refine that into the most high risk. That doesn’t mean that those who are the sort of lower level, especially if they’re overweight, shouldn’t be being encouraged to become more active and lose weight.
Porter
Margaret, let’s pick up on Prof Gale’s other concern and that was that there’s no age adjustment. Given that this to some extent is a natural process, as we get older all of our sugar levels creep up a little bit, it’s surprising that the diagnostic criteria don’t reflect age as one of the criteria for interpreting it?
McCartney
Well I think that GPs will often use discretion but the problem is that we’re judged by guidelines, we’re judged by QOF points in terms of what we’re meant to do, it’s meant to be a one size fits all to a certain extent. And I think we need much more leeway in order to have a bit of flexibility about how we interpret the data really when it comes to asymptomatic older people especially if those older people are frail. I think the medical industrial complex is really all for diagnosing things earlier, faster but we very rarely I think consider the harms that we do when we do that at the same time. And for older people I don’t think we accept what normal is enough.
O’Neill
I think we have to be very careful about how we interpret this and not over-medicalise, exactly as Margaret says.
Porter
It may be normal for them.
O’Neill
Exactly.
McCartney
Absolutely. I mean you’re trying to pick up people who don’t have any symptoms from diabetes, so people who are otherwise well. What you’re really trying to do is prevent complications that will happen over decades if a diabetic state is left untreated. And if you’re already 75 or 80 it might take a couple of decades to start developing complications so the benefits that you might get from treatment are pretty low.
Porter
Okay, so the last of Professor Gale’s concerns and that’s the three different tests that we’re using, I mean I have to write them down every time because I forget the figures, I’m sure you’ve committed them to memory, but it is confusing, are we going to go with the one test?
O’Neill
Personally I think the HBA1c test is probably where most people are going but it is confusing and I’d hate to be a GP out there trying to decide what’s the best thing to do.
Porter
Simon O’Neill from Diabetes UK. And, if you are one of those GPs or nurses, then the type of test - and the thresholds that are going to be used for the national Type 2 diabetes prevention programme, that Simon mentioned there - should be announced over the next month or so.