I agree with much of what John Yudkin says here, but when he mentions 'harms of overdiagnosis -a label of pre-diabetes brings problems of self image'. I must point out that this very much depends on how the clinician uses this information.
In my practice I have found the diagnosis of pre-diabetes to be an ideal opportunity to have a 'lifestyle review' with my patients. In this the HbA1c result needs weighing up along with other factors such as weight, waist measurement, liver function tests, BP and so on.
At the point of having a raised HbA1c result I find the patient particularly interested in exploring improvements in lifestyle- particularly diet. We discuss the choices open to them, especially the idea of reducing sources of sugar.
Surprisingly out of 26 newly diagnosed pre-diabetics and type 2 diabetics I have interviewed over the past year- 24 have cheerfully joined our practice weight loss group (with me!) and far from this resulting in 'problems of self-image' they are proud of taking control of their lives, seven patients came off medication.
Results: Paired t test
Weight (Kg) pre diet 100.9 (93.4, 108.3), post diet 91.3 (83.6, 99.0) p<0.001
HbA1(mmol/mol) pre diet 50.2 (45.5, 55.0), post diet41.2 (38.2, 44.1) p<0.001
I feel we have all eaten our way into this diabesity epidemic and we must all take every opportunity to help patients eat their way out of it again.
John Yudkin asks for a shift in perspective - I suspect it would help if doctors prioritized working on lifestyle changes with our patients well before initiating drug therapy. The diagnosis of pre-diabetes far from being a threat can be a turning point and a golden opportunity.
Ref; Unwin DJ, Low carbohydrate diet to achieve weight loss and
improve HbA1c in type 2 diabetes and pre-diabetes:
experience from one general practice. Practical Diabetes 2014; 31(2): 76–79
Rapid Response:
I agree with much of what John Yudkin says here, but when he mentions 'harms of overdiagnosis -a label of pre-diabetes brings problems of self image'. I must point out that this very much depends on how the clinician uses this information.
In my practice I have found the diagnosis of pre-diabetes to be an ideal opportunity to have a 'lifestyle review' with my patients. In this the HbA1c result needs weighing up along with other factors such as weight, waist measurement, liver function tests, BP and so on.
At the point of having a raised HbA1c result I find the patient particularly interested in exploring improvements in lifestyle- particularly diet. We discuss the choices open to them, especially the idea of reducing sources of sugar.
Surprisingly out of 26 newly diagnosed pre-diabetics and type 2 diabetics I have interviewed over the past year- 24 have cheerfully joined our practice weight loss group (with me!) and far from this resulting in 'problems of self-image' they are proud of taking control of their lives, seven patients came off medication.
Results: Paired t test
Weight (Kg) pre diet 100.9 (93.4, 108.3), post diet 91.3 (83.6, 99.0) p<0.001
HbA1(mmol/mol) pre diet 50.2 (45.5, 55.0), post diet41.2 (38.2, 44.1) p<0.001
I feel we have all eaten our way into this diabesity epidemic and we must all take every opportunity to help patients eat their way out of it again.
John Yudkin asks for a shift in perspective - I suspect it would help if doctors prioritized working on lifestyle changes with our patients well before initiating drug therapy. The diagnosis of pre-diabetes far from being a threat can be a turning point and a golden opportunity.
Ref; Unwin DJ, Low carbohydrate diet to achieve weight loss and
improve HbA1c in type 2 diabetes and pre-diabetes:
experience from one general practice. Practical Diabetes 2014; 31(2): 76–79
Competing interests: No competing interests