Millions of people do not have their blood sugar in order. They tend to be the same ones that often state, without giving it much importance: “I don’t have diabetes , just a little sugar.” True, they are not diabetic, but their blood glucose levels tell their doctors that something is not quite right. Twenty years ago, a new concept was born to these people: prediabetes, a term for doctors and patients to take rising sugar seriously and curb possible type 2 diabetes. However, the label refuses to go down the street. , and at the same time it is questioned by expert voices.
Those critical positions are collected by the journal Science in a recent article , which values prediabetes as a condition that adds to the debated medicalization , with a high cost in campaigns and treatments without the support of scientific evidence. Created by the American Diabetes Association (ADA), prediabetes has been proposed as an alternative to the historical, and much more widespread, concept of impaired fasting blood glucose. The purpose of the change is to respond to the serious increase in obesity and diabetes on a global scale by attending to the early signs. One of the first jobsin pointing out the early diagnosis of diabetes were those of Dr. Enrique Caballero, from the Harvard Medical School, whose results indicated that between 5 and 10% of prediabetic people end up having diabetes the following year , and around 50% after ten years. Those data spurred the United States Centers for Disease Control and Prevention (CDC) to join in declaring war on prediabetes , understood as the way to end diabetes, a disease that can lead to amputations, blindness and heart attacks.
A discussed prevention
Like almost everything in preventive medicine, prediabetes is not spared from debate, and many scientists question the need to identify and treat prediabetes as defined by the ADA, an entity that between 2004 and 2010 expanded the range of blood sugar considered prediabetic among 100 and 126 mg / dl instead of the classic 110-140 mg / dl range, creating tens of millions of potential patients at a stroke in the United States. “It is controversial because it encompasses more people without a sufficiently high risk of diabetes,” says Javier García Soidán, member of the Board of Trustees of the Network of Diabetes Study Groups in Primary Health Care (redGDPS).
Over the years, other scientific studies such as the 2018 review of the Cochcrane Collaboration , which showed that 59% of prediabetic patients returned to normal glycemic values within a range of one to 11 years without treatment , have come to question the need of the prediabetic diagnosis, which has caused that not a few specialists come to see it in prediabetes as an alarmist measure, without clearly seeing its benefits.
Although the medical consensus supports a healthy diet and regular physical exercise to keep sugar under control, and it is widely accepted that somewhat elevated glucose levels can evolve into diabetes, the divergence appears on fundamental questions. For example, how the frequency and rapidity with which prediabetic people progress to diabetics, and to what extent prediabetes is harmful when a patient’s levels are at the lower end of the spectrum. In fact, the CDC, which originally argued that between 15% and 30% of patients with untreated prediabetes develop diabetes within five years, has lowered the figure when characterizing risk to less than 2% by year, and less than 10% in five.
A problem that can be reversed
“Society neither knows prediabetes nor diabetes. Although it is estimated that 6 million people are diabetic in Spain, 1.5 million are unaware of it. Prediabetes is used to locate people who have it. The fundamental thing is to understand that prediabetes is it can reverse, diabetes cannot, “ says Andoni Lorenzo, president of the Spanish Diabetes Federation (FEDE), who values prediabetes as an opportunity to raise awareness among the” terrifying “data on diabetes in Spain: 25,000 people die a year due to diabetes, which translates to 68 deaths a day.
For Lorenzo, it is not alarming to anticipate the disease by cutting levels, taking into account that 1,100 cases of diabetes are diagnosed daily. “It is a way of changing the vision and methodology of diagnosis and prevention. In the street, the disease is still trivialized, although we lead the amputations related to diabetes in Europe and health spending exceeds that of the Ministry of Defense,” observes the president of the FEDE.
A similar reading is shared by endocrinologist Alfonso López Alba, head of communication for the Spanish Diabetes Society (SED): “Prediabetes does not imply turning healthy people into patients, but rather indicates strategies to improve therapeutic education, but measures such as Nursing specialization as in other fields such as surgery, psychiatry and gynecology. Diabetes is the disease that we can best treat from the beginning, no other can better take back the reins of our genetics by changing our lifestyle , and that it is something to take into account when we know that diabetes triples the average health cost, “stresses this specialist.
Profit at a reasonable cost
In Spain, the PREDAPS study , which has evaluated prediabetes for five years, places the glucose level cut that best predicts the development of diabetes at 110 mg / del, as also defended by the World Health Organization (WHO). ” The range between 110 and 140 glucose has a great benefit at a reasonable cost , but lowering it to 100 causes the cost to skyrocket with a fairly low risk. In Spain, it is not effective,” says García Soidán, co-author of the study.
In addition to fasting baseline blood glucose , the most widely used diagnosis, other methods to assess prediabetes are glucose overload , especially in pregnant women, a intake of between 75 and 100 grams of fasting glucose whose level is measured after one or two hours, and glycosylated hemoglobin , a diagnosis based on three-month evaluation of red blood cells that have been incorporated strongly in recent years, and which establishes prediabetes when the level exceeds 5.7%. “We have verified that between 5.7% and 6% the risk is very low. To be effective, it must be above 6%,” says this family doctor.
Not only diabetes is at stake
The risk of prediabetes is not limited to developing diabetes. It has been seen that between 70 and 80% of prediabetic people suffer from metabolic syndrome with a poor long-term prognosis, and it is also associated with overweight and obesity between 80 and 90% of those affected. “In Spain, people with blood glucose between 110 and 126 mg / dl are considered a high-risk population, and with glycated hemoglobin between 6-6.5%, and those with both altered conditions are at enormous risk,” García describes. Soidan.
Despite the risks, the mistrust he plans for diabetes is related to the possible creation of new patients for the pharmaceutical business, something somewhat unsupported according to García Soidán, who recalls that metformin, indicated for diabetes, can reduce the risk of develop prediabetes , according to the International Diabetes Federation, in people with weight problems, under 60 years of age, in whom lifestyle guidelines did not work, although it is not approved by health authorities for prediabetic people due to lack of evidence on its effectiveness. “There are medications for diabetes or obesity that may work, but the biggest benefit is diet and exercise, which reduces the risk by up to 60%. This is about prevention through habits, rather than medication, “concludes this family doctor.