Is Prediabetes Being Overdiagnosed? Analysis from Experts

The diagnosis of prediabetes is a subject of debate due to the potential stress it could cause in individuals with low risk and its important role in early intervention to prevent severe health problems in high-risk individuals.

Prediabetes is a diagnosis designed to prevent diabetes by identifying people at high risk, yet it is contentious. Critics argue it results in unnecessary anxiety and expenses for individuals at low risk, while proponents see it as an essential chance for early intervention in people displaying symptoms of metabolic syndrome.

The diagnosis of prediabetes, intended to detect individuals at high risk and prevent the progression to diabetes, continues to be a heated subject of discussion. Specialists are split over the criteria for screening, how it should be interpreted, and its ramifications.

An expert in epidemiology and health services research contends that prediabetes is overdiagnosed. For patients like her who have a low risk of developing type 2 diabetes, a prediabetes diagnosis could be more detrimental than beneficial. Such individuals could face unwarranted stress, undergo unneeded consultations and tests, and incur extra healthcare expenses.

There is a common—yet incorrect—assumption that prediabetes will inevitably turn into diabetes. The author believes that clinicians should concentrate on identifying and treating patients at high risk or already have diabetes: "Let's put out fires, not fan flames."

In contrast, a family physician contends that a prediabetes diagnosis represents a crucial stage for intervention in primary care. Prediabetes may indicate that an individual has metabolic syndrome, which elevates the risk of mortality from all causes, cardiovascular disease, common cancers, and neurocognitive disorders. To provide a comprehensive health assessment without causing patient anxiety, doctors should not overly rely on a single biomarker.

The physician provides three hypothetical case studies to highlight the complexities of diagnosing and managing prediabetes. He concludes, "With recognizing early signs and adopting a holistic view of patient health, family physicians can play a pivotal role in preventing the long-term risks linked with prediabetes and metabolic syndrome, and ultimately enhancing patient outcomes and quality of life."

Experts now know that type 2 diabetes is a preventable disease. However, there is disagreement over who is at a greater risk and who would be a suitable candidate for preventive measures. The balance between the potential damage of overdiagnosing prediabetes and early intervention opportunities to stop its progression is complex. Patient-centric counseling and patient preferences are critical in these discussions.

References:

“Is Prediabetes Overdiagnosed? Yes: A Patient Epidemiologist’s Experience” by Rani Marx, PhD, MPH, 28 May 2024, Annals of Family Medicine. DOI: 10.1370/afm.3093

“Is Prediabetes Overdiagnosed? No: A Clinician’s Perspective” by Jonathan G. Gabison, MD 28 May 2024, Annals of Family Medicine. DOI: 10.1370/afm.3101