The Delusion of “Pre-Diabetes”

Drop the term, “pre-diabetes,” from your clinical vocabulary. It is a peculiar conceit that gives you and your patients a false sense of security, advised Mark Hyman, MD, at a symposium on Effective Therapies for Reversing Heart Disease & Diabetes.

In metabolic reality, the condition so described is not “pre” anything; it is dysregulated glucose metabolism that will eventually cause serious problems if left unchecked. It is the same disease process as “full-blown Type 2 diabetes,” it just hasn’t progressed to the point of crossing the consensus-based diagnostic thresholds.

People with “metabolic syndrome” or “pre-diabetes” still have the same increased lifetime risk for cardiovascular events, strokes, and many types of cancer as people with “frank” diabetes; they just haven’t reached the end stages yet, said Dr. Hyman, founder of the UltraWellness Center, and chairman of the Institute for Functional Medicine.

Instead of comforting people with the mollifying idea that they don’t really have a disease, doctors should be doing all they can to motivate these patients to make meaningful lifestyle changes at a stage when such changes really could make the greatest difference in their lives.

Already, one in every three Medicare dollars is spent on diabetes-related problems; and we’re just getting started. Well over 15% of all new type 2 diagnoses are in people under age 20, and there has been a 35% increased incidence of stroke in 5-13 year olds in recent years.

“We’re spending more and more and we’re failing. We have to come up with different solutions, because the problems are getting worse, they’re not getting better,” he stressed. Fooling ourselves and our patients with delusional terms like “pre-diabetes” is not helping the situation.

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