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Dubious diagnosis

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Science  08 Mar 2019:
Vol. 363, Issue 6431, pp. 1026-1031
DOI: 10.1126/science.363.6431.1026

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  • Dubious Diagnosis, Bad Medicine
    • Lewis Kuller, Professor Emeritus of Epidemiology, University of Pittsburgh Graduate School of Public Health

    The recent paper in Science, “Dubious diagnosis. A war on “prediabetes”…”(1) is misleading. The lifetime risk of developing diabetes is about 33% for men, 39% for women.(2) Almost all diabetics went through a period of increased fasting glucose or elevated glycohemoglobin (HbA1c) with increased loss of beta cell function and insulin resistance (IR) leading to metabolic changes associated with increased risk of microvascular and macrovascular disease. By the time of diagnosis of diabetes, the patient has subclinical macro- and microvascular disease.(3-7)

    Blood sugar levels in the population are linear and continuous variables. The risk diabetes is linearly related to the levels of blood glucose. Genetic studies have documented that a combination of polymorphisms and lifestyles are the primary determinants of type 2 diabetes (T2D). Mendelian randomization has shown that genes related to increasing blood glucose are associated with the risk of CVD.(8) Conversion rates from hyperglycemia or elevated HbA1c to diabetes is probably about 5%/year. Some individuals with elevated HbA1c or glucose revert to normal in the short term due to regression to the mean.(9)

    Five approaches can be used to prevent the development of diabetes and reduce burden of CVD among individuals with elevated blood glucose.(10) First, nonpharmacological approaches (DPP).(11, 12) Second, the use of drugs, such as metformin.(13) Third, bariatric surgery.(14) Fourth, treatment of comorbid risk...

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    Competing Interests: None declared.

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