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The epidemic of pre-diabetes: the medicine and the politics

    A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by John R. Radford.

    Abstract

    'Medical science has made such tremendous progress that there is hardly a healthy human left.' Aldous Huxley.

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    Yudkin YS, Montori VM. BMJ 2014; 349: g4485 doi: 10.1136/bmj.g4485

    When adopting the American Diabetic Association category for pre-diabetes, it was reported that over half the population of China have pre-diabetes, some 493.4 million people. But what are the implications of this finding? These authors argue that 'current definitions (for pre-diabetes) risk unnecessary medicalisation and create unsustainable burdens for healthcare systems.' Of note, fewer than one half of those with pre-diabetes develop diabetes in the next ten years. When considering diabetes, diagnosis is based on the somewhat arbitrary threshold of risk for retinopathy, and to a lesser degree, arterial disease. The different weighting ascribed to tests (glucose tolerance testing, fasting plasma glucose and now HbA1c) have further muddied the waters. In addition, people of 'black African heritage' have higher markers of glycaemia than other ethnic groups and, glucose tolerance deteriorates with ageing. In a recent study (BMJ Open 2014; 4: e005002.) using data from the Health Survey for England, the 'prevalence rate of prediabetes increased from 11.6% to 35.3% from 2003 to 2011.'

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    The epidemic of pre-diabetes: the medicine and the politics. Br Dent J 217, 363 (2014). https://doi.org/10.1038/sj.bdj.2014.880

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