Point/counterpoint: Is prediabetes overdiagnosed?

Background: Prediabetes, a diagnosis intended to identify high-risk persons and prevent progression to diabetes, has been a topic of ongoing debate, and experts continue to disagree about its screening criteria, interpretation, and implications.

Author Stance: An epidemiologist and health services researcher argues that prediabetes is overdiagnosed. A prediabetes diagnosis for patients like herself who are at low risk of developing type 2 diabetes can cause more harm than good. They may experience undue distress, undergo unnecessary consultations and tests, and pay additional health care costs. It may be implied—incorrectly—that prediabetes will inevitably develop into diabetes. Ultimately, the author feels, clinicians should focus on identifying and treating patients at high risk or with diabetes: “Let’s put out fires, not fan flames.”

Conversely, a family physician argues that a prediabetes diagnosis “represents a crucial stage for intervention in primary care.” Prediabetes can signal an individual has metabolic syndrome, which increases the risk of all-cause mortality, cardiovascular disease, risks of common cancers, and neurocognitive disorders. To provide a comprehensive health assessment—and to avoid causing patients anxiety—physicians shouldn’t over-rely on a single biomarker. He presents three hypothetical case studies to illustrate the complexities of diagnosing and managing prediabetes. He concludes, “By recognizing the early signs and adopting a holistic view of patient health, family physicians play a pivotal role in preventing the long-term risks associated with prediabetes and metabolic syndrome, and ultimately improving patient outcomes and quality of life.”

Why It Matters: We now know that type 2 diabetes is a preventable disease. There is disagreement about who is at higher risk and who would be a good candidate for preventive interventions. Balancing potential harms of overdiagnosing prediabetes with opportunities for early intervention to prevent progression is complex. Patient-centered counseling and patient preferences matter in these discussions.

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

Rani Marx, PhD, MPH

Initiative for Slow Medicine, Berkeley, California

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Is Prediabetes Overdiagnosed? No: A Clinician’s Perspective

Jonathan G. Gabison, MD

University of Michigan Family Medicine, Ann Arbor, Michigan 

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