Risk test may put too many in unhelpful 'prediabetes' category

(Reuters Health) - A widely supported web-based risk test suggests that 8 out of 10 people aged 60 years and older in the U.S. are at high risk for so-called prediabetes – but it may not be helpful to label so many people as “high risk,” researchers say.

The term prediabetes refers to having elevated blood sugar that does not reach the threshold for type 2 diabetes, but it is considered a sign that a person might be headed in that direction. Older age, obesity and family history increase the risk of prediabetes, which in turn increases risk for diabetes, heart disease and stroke, according to the Centers for Disease Control and Prevention (CDC).

Scientific societies need to be careful when they publicly announce a risk calculator or widget, said lead author of the new study, Dr. Saeid Shahraz, an investigator in the Predictive Analytics and Comparative Effectiveness Center at Tufts Medical Center in Boston.

“Our findings show that this risk engine identifies a lot of normal people as having prediabetes,” Shahraz told Reuters Health.

“Second, even the person who has prediabetes doesn’t necessarily progress toward diabetes,” he said. “Overall we think this is putting too much pressure on society of creating or pushing toward more disease labels for the healthy population.”

The researchers used existing data from the 2013-2014 National Health and Nutrition Examination Survey of adults aged 18 and older without diabetes to calculate risk scores for prediabetes based on seven factors: age, sex, history of gestational diabetes, family history of diabetes, history of high blood pressure, physical activity and weight. All factors were worth one risk point except weight and age, which were worth from one to three points.

About 10,000 respondents who were representative of the U.S. population were included in the analysis. A total score of five or more points put an individual at risk for prediabetes.

Based on this scoring system, 73.3 million Americans, or almost 60 percent of the population, are at high risk for prediabetes, according to the results published in JAMA Internal Medicine. For those aged 60 and older, 80 percent qualified as high risk for prediabetes.

For people with prediabetes, physicians emphasize exercise and maintaining a healthy diet, Shahraz said.

“Healthy diet and physical activity is useful across the board, for healthy people as well,” he said.

Shahraz’s team also notes in their report that scoring as “high risk” for prediabetes with this calculator garners a recommendation to visit a doctor and get a blood sugar test. If everyone followed that advice, it could potentially use so many medical resources that people with actual diabetes or other chronic conditions might not be able to access the healthcare they need.

“The important thing to focus on is that there’s increasing obesity which leads to a variety of obesity-related conditions, but labeling them with these pseudomedical terms like prediabetes isn’t particularly helpful,” said Dr. Rita F. Redberg, the editor of JAMA Internal Medicine.

We don’t need to categorize people by diabetes risk to recommend weight loss, she said in a phone interview.

In an editor’s note accompanying the report, Redberg writes that the results of this study “elegantly” demonstrate how common conditions can be “medicalized,” noting that the term prediabetes was “never heard of 10 years ago.”

“Diabetes prevention programs are essentially weight loss programs,” she told Reuters Health. “If you’re overweight or obese you should be working on weight loss.”

If prediabetes could be treated by some specific means other than lifestyle changes, it may be more worthwhile to label people as prediabetic, Redberg added.

SOURCE: and JAMA Internal Medicine, online October 3, 2016.