Experts say there are several drawbacks to diagnosing prediabetes, including overdiagnosis, overtreatment, causing unnecessary anxiety and stress in patients, and the financial burden of tests and treatments.
Overdiagnosis of Prediabetes and Overtreatment
Overtreatment is also an issue. While addressing prediabetes is crucial for preventing type 2 diabetes and related health issues, intervening too much can lead to unnecessary stress and complications, says Maria Teresa Anton, MD, endocrinologist and educator at Pritikin Longevity Center in Miami.
“Overzealous intervention, such as excessive medication or overly restrictive diets, may not only diminish a patient’s quality of life but also foster anxiety around food and health,” she says. “It’s important to focus on balanced, evidence-based lifestyle modifications that promote long-term well-being rather than solely aiming for clinical numbers. A thoughtful, individualized approach ensures that patients are supported in making sustainable changes without the risks associated with overtreatment.”
Weighing the Pros and Cons of Medication
However, while certain medications can reduce diabetes risk, they may not be necessary for everyone diagnosed with prediabetes, especially for those at a low risk of progression, says La’Tonzia Adams, MD, a clinical pathologist and representative for the College of American Pathologists (CAP) in Portland, Oregon.
“Unnecessary medication introduces the potential for side effects, which can lower patients’ quality of life and adherence to treatment plans,” she says, noting that glucose levels are only one of several factors that can indicate a person’s risk of disease progression.
Variations in Prediabetes Diagnosis
Another criticism of diagnosing prediabetes is that variations in diagnostic criteria and inconsistencies in A1C levels and fasting glucose measurements can create confusion among clinicians and patients, Dr. Anton says.
As mentioned above, criteria for diagnosing prediabetes can differ from organization to organization, such as from the ADA to the WHO.
The test results can also be problematic. Discrepancies in A1C and fasting glucose results may arise due to variations in red blood cell turnover (as seen in people with anemia or other blood conditions), changes in red blood cell production, or certain genetic variants, Anton explains.
Additionally, she says, A1C test results may not fully reflect glucose level fluctuations that happen after eating or during periods of hypoglycemia (low blood sugar).
Another downside of the A1C test is that levels can vary among people of different ethnicities and races, Ortiz-Pujols notes. In particular, non-Hispanic Black people tend to have higher A1C levels than white people.
“These discrepancies may lead to misdiagnosis, inappropriate treatment strategies, and a lack of standardized care,” says Anton, pointing to the need for “more unified guidelines and better education for both healthcare providers and patients.”
Ethical Considerations
While “medicalization” of a non-disease like prediabetes can be controversial, a prediabetes diagnosis can help equip patients with the tools they need to stave off not only type 2 diabetes but also associated long-term health risks like kidney disease and heart disease.
“Without the medicalization of [prediabetes], the onus of action is left on the person affected by the condition, which we know does not necessarily activate nor empower the person to do something to reverse the course of the condition,” Ortiz-Pujols says. Medicalization can facilitate more research on the issue as well as effective prevention strategies, she adds.
Deciding whether to diagnose a patient with prediabetes requires careful ethical consideration, Dr. Adams says. If the diagnosis leads to unnecessary anxiety, expense, and interventions without clear evidence of benefit, it could arguably harm patients more than it helps them, and raise questions about whether the diagnosis primarily serves the patient or other interests.
“The question of whether the ‘pre-disease’ state should be treated, and how aggressively, raises important ethical issues,” she explains. “Addressing these issues involves balancing prevention with the risks of overtreatment, ensuring that healthcare practices are not primarily driven by pharmaceutical or medical industry incentives but are genuinely aimed at promoting long-term health and well-being.“
The Business of Prediabetes
Adams draws a parallel to other conditions that may be overdiagnosed and overmedicated. For example, recommending medication for people with borderline high blood pressure can be controversial, since lifestyle changes may be equally effective.
“Treating mild hypertension pharmacologically can create a dependency on medication while sometimes failing to address underlying health behaviors, raising similar questions about whether this approach best serves patients’ health,” she says.
However, intervention can be critical for those who are truly at risk of developing diabetes.
“This debate boils down to finding a balanced approach — one that doesn’t underplay the risks for those truly on the path to diabetes while avoiding unnecessary treatment for those unlikely to progress,” Adams says.
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