Is Prediabetes Overdiagnosed? Yes: A Patient-Epidemiologist’s Experience

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