We read with interest the point-of-view of Yudkin and Montori who, questioning the value of pre-diabetes as a clinical entity, suggest putting the term in “cold storage” [1].
We suggest that many of the concerns raised around disease-labelling are widely held and indeed this position reflects the WHO/IDF consensus guideline for the HbA1c range 6.0–6.4% termed “intermediate hyperglycaemia” [2].
Whilst advocating that the definition “pre-diabetes” should be restricted and used appropriately, to abolish it would firstly neglect the accepted wealth of data around IFG and IGT elegantly described in the article, and secondly would eliminate a readily comprehensible public health message and marker of a condition carrying a recognised increased risk of cardiovascular disease.
Moreover, as reported in the article, available observational evidence would indicate a graded continuum of the risk of vascular events for FPG values ≥5.6 mmol/L (≥100 mg/dl) in subjects not on anti-hyperglycaemic treatment [3, 4]; therefore, using such rationale not only the definition of “pre-diabetes”, but also of “diabetes”, should be questioned.
Lastly, the existing evidence over the psychological harm of being defined as “pre-diabetic” is very limited [5, 6].
In conclusion, we believe that the term “pre-diabetes” should not be abandoned, but used objectively within existing terms of reference for plasma glucose.
References
1. Yudkin JS, Montori VM. The epidemic of pre-diabetes: the medicine and the politics. BMJ 2014;349:g4485.
2. http://www.idf.org/webdata/docs/WHO_IDF_definition_diagnosis_of_diabetes... accessed 24/07/2014
3. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 2011;364:829-41.
4. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010;375:2215-22.
5. Andersson S, Ekman I, Lindblad U, Friberg F. It's up to me! Experiences of living with pre-diabetes and the increased risk of developing type 2 diabetes mellitus. Prim Care Diabetes 2008;2:187-93.
6. Troughton J, Jarvis J, Skinner C, Robertson N, Khunti K, Davies M. Waiting for diabetes: perceptions of people with pre-diabetes: a qualitative study. Patient Educ Couns 2008;72:88-93.
Competing interests:
No competing interests
12 August 2014
Francesco Zaccardi
Clinical Research Fellow
David Webb; University of Leicester, Diabetes Research Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, England
University of Leicester
Diabetes Research Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, England
Rapid Response:
We read with interest the point-of-view of Yudkin and Montori who, questioning the value of pre-diabetes as a clinical entity, suggest putting the term in “cold storage” [1].
We suggest that many of the concerns raised around disease-labelling are widely held and indeed this position reflects the WHO/IDF consensus guideline for the HbA1c range 6.0–6.4% termed “intermediate hyperglycaemia” [2].
Whilst advocating that the definition “pre-diabetes” should be restricted and used appropriately, to abolish it would firstly neglect the accepted wealth of data around IFG and IGT elegantly described in the article, and secondly would eliminate a readily comprehensible public health message and marker of a condition carrying a recognised increased risk of cardiovascular disease.
Moreover, as reported in the article, available observational evidence would indicate a graded continuum of the risk of vascular events for FPG values ≥5.6 mmol/L (≥100 mg/dl) in subjects not on anti-hyperglycaemic treatment [3, 4]; therefore, using such rationale not only the definition of “pre-diabetes”, but also of “diabetes”, should be questioned.
Lastly, the existing evidence over the psychological harm of being defined as “pre-diabetic” is very limited [5, 6].
In conclusion, we believe that the term “pre-diabetes” should not be abandoned, but used objectively within existing terms of reference for plasma glucose.
References
1. Yudkin JS, Montori VM. The epidemic of pre-diabetes: the medicine and the politics. BMJ 2014;349:g4485.
2. http://www.idf.org/webdata/docs/WHO_IDF_definition_diagnosis_of_diabetes... accessed 24/07/2014
3. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 2011;364:829-41.
4. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010;375:2215-22.
5. Andersson S, Ekman I, Lindblad U, Friberg F. It's up to me! Experiences of living with pre-diabetes and the increased risk of developing type 2 diabetes mellitus. Prim Care Diabetes 2008;2:187-93.
6. Troughton J, Jarvis J, Skinner C, Robertson N, Khunti K, Davies M. Waiting for diabetes: perceptions of people with pre-diabetes: a qualitative study. Patient Educ Couns 2008;72:88-93.
Competing interests: No competing interests