Labelling patients as pre-diabetic is "a drastically premature measure with no medical value," a senior British doctor claims today.
People with moderately high blood sugar are often called pre-diabetic, meaning they may be on the path to developing type 2 diabetes.
Some recent studies have warned of large numbers of people with this condition.
Professor John Yudkin, of University College London, UK, and his team examined whether the label tends to improve diabetes prevention through current interventions.
The latest guidelines from the American Diabetes Association define people with haemoglobin A1c – a measure of blood sugar over the previous three months – between 5.7% and 6.4% as having pre-diabetes. The level for type 2 diabetes itself is above 6.5%.
Professor Yudkin points out that if these guidelines were used in the UK, a third of the adult population would be labelled as pre-diabetic.
The consequent need to treat all these people would put "significant burdens on healthcare systems", while the treatments themselves are not even very effective. In fact, type 2 diabetes treatments can do more harm than good, he warns in The BMJ.
"Pre-diabetes is an artificial category with virtually zero clinical relevance," said Professor Yudkin. "There is no proven benefit of giving diabetes treatment drugs to people in this category before they develop diabetes, particularly since many of them would not go on to develop diabetes anyway.
"Sensibly, the World Health Organisation and the National Institute for Health and Care Excellence [NICE] and the International Diabetes Federation do not recognise pre-diabetes at present. But I am concerned about the rising influence of the term.
"We need to stop looking at this as a clinical problem with pharmaceutical solutions and focus on improving public health. The whole population would benefit from a more healthy diet and more physical activity."
Yudkin, J. et al. The epidemic of pre-diabetes: the medicine and the politics. BMJ 16 July 2014
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