The authors say this is because the ADA has lowered the thresholds for impaired fasting glucose and glycated haemoglobin. Because it encompasses all three aspects of impaired glucose metabolism (impaired glucose tolerance, above normal fasting blood glucose, above normal glycated haemoglobin), the lowered thresholds have created a large, poorly characterised and heterogeneous (mixed) category of glucose intolerance.
In other words, the diagnostic criteria are now so broad (in the opinion of the authors) that it is, essentially, useless.
The authors say that using the ADA’s definition of prediabetes would result in two to three times as many people being diagnosed with impaired glucose metabolism. This would lead to 50% of Chinese adults being diagnosed with prediabetes – over half a billion people.
The authors also question the value of diagnosing people with prediabetes.
They point out that the drugs used to treat people with prediabetes in order to stop them developing diabetes are often the same as the drugs they would take if they actually developed diabetes.
The side effects of these drugs must be measured against the fact that many people with prediabetes, who remain untreated, will not go on to develop the condition.
They also discuss the merits of lifestyle interventions, such as regular exercise and improved diet.
They point out that these types of interventions are of use for all adults, so they question the wisdom of only promoting these interventions to specific groups. A better use of campaigning would be to target all adults, they say.
What dangers or risks do they claim could occur by using the term?
The authors suggest that a label of prediabetes, while not causing any physical symptoms, could still cause:
problems with self-image
anxiety about future complications
challenges with insurance and employment
a need for medical care and treatment
increased healthcare costs
medication side effects, if prediabetes is treated with drugs
In their opinion, the diagnosis would cause more problems than it solves.
What do the researchers suggest instead?
The researchers say that the risk factors for developing a whole host of chronic diseases overlap, and that money would be better spent changing food, education, health and economic policies.
What should I do if I have been told I have prediabetes or that I am at high risk of developing diabetes?
If you have been told you have prediabetes, or that you have a high risk of developing diabetes, you can reduce your risk of developing the illness by: