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- Page navigation anchor for RE: Prediabetes OverdiagnosedRE: Prediabetes Overdiagnosed
Medicine has many issues due to definitions. When we define a "disease" solely on a slightly abnormal number obtained by a machine (CKD, Hypertension, Hyperlipidemia, Diabetes) without using any clinical judgment we overestimate conditions as diseases. We have normal lab value deflation, where what is considered normal is more and more becoming downgraded so that what used to be normal is now a disease. We certainly don't consider the "slop" ( normal lack of precision in repeated measurements) in the numerical values our machines produce; a 2% margin of error is NOT understood by computer artificial intelligence, and so any number over or under a "laboratory normal" is red flagged as a disease. We have to use some clinical judgment. How can 1/3 of normal humans have a "disease" rather than having a tendency for a condition? Why does the definition of a disease change every few years on the recommendation of a handful of academics, especially when we know there is a continuum of risks correlating to measurements of an individual parameter? Our definitions are leading us down a path of overdiagnosis and overtreatment for what should be behavioral and social conditions. Lets bring back some clinical judgment as to whether an abnormal lab value is important, something which no AI machine or program can judge. IS it worth it (to label a human as having a disease)?
Marc S. Berger, MD,CM, FAAFP
Competing Interests: None declared. - Page navigation anchor for RE: prediabetesRE: prediabetes
I read with great interest the two articles with regard to this timely subject. And as is often the case, the truth sits between the two opposing points of view. As we have come to understand, hyperinsulinemia is rampant as the causal factor for type two diabetes, metabolic syndrome, perhaps metabolic fatty liver disease, PCOS and acanthosis nigricans just to name what comes to mind quickly. The causes of hyperinsulinemia are obesity and genetics both causing insulin resistance. The issue is the percentage of individuals with A1C values between 5.7%-6.4% who evolve into true diabetes as defined by an A1C above 6.4%. It has been proven that “treating” prediabetes with metformin among other medications does not generally affect the transition to true type 2 diabetes. Much as with “prehypertension”, another category open for debate, the concept of “prediabetes” provides a marker that can and perhaps should provoke better attention to preventative medicine and risk factor analysis, a role for which we as family medicine providers, are ideally suited. Jonathan R. Dreazen, MD
Competing Interests: None declared.