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Pre-diabetes diagnosis could place ‘unmanageable demand’ on NHS

Using the term

Using the term to describe patients with blood glucose levels that are above normal but below that of a diabetic had come to “dominate scientific literature” but it risked causing people to receive treatment unnecessarily, say researchers at UCL and the Mayo Clinic in Minnesota

Diagnosing people with ‘pre-diabetes' is unnecessary and could place an "unsustainable burden" on the NHS, researchers have warned.


Using the term to describe patients with blood glucose levels that are above normal but below that of a diabetic had come to "dominate scientific literature" but it risked causing people to receive treatment unnecessarily, researchers at University College London (UCL) and the Mayo Clinic in Minnesota said in a report published in the BMJ last week (July 16).


The American Diabetes Association (ADA) had been referring to people with blood sugar levels of 5.7 per cent or above as ‘pre-diabetic' since 2010. But this definition covered a third of the UK adult population who would place an "unmanageable demand" on health services if they were all provided with personalised lifestyle advice or given medication, UCL said.


Instead, an international diabetes committee had recommended that preventive interventions should only be given to people with a blood sugar level of 6 per cent or higher, researchers said.


The term ‘pre-diabetes' implied an "inevitable progression" to becoming a diabetic and "risked stigmatisation", said UCL. But there was no certainty that individuals with pre-diabetes would develop diabetes and an analysis of data had shown that more than half of patients with impaired glucose tolerance - a condition associated with a high risk of diabetes - were free of diabetes 10 years later, the researchers added.


UCL emeritus professor of medicine John Yudkin said he was concerned by the "rising influence" of the term ‘pre-diabetes', which was an "artificial category with virtually zero clinical relevance".


The main beneficiaries of the ADA's use of the term would be drug manufacturers, which would start to see "significant swathes" of the population within their market, Professor Yudkin said.


"The whole population would benefit from a more healthy diet and more physical activity, so it makes no sense to single out so many people and tell them that they have a disease," he added.


Earlier this month, researchers at UCL suggested clinicians should make decisions about treating patients with type 2 diabetes based on the realistic benefits rather than their blood sugar level.



How has the increasing incidence of diabetes affected your practice?

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1 Comments

RAJ RAI, Community pharmacist

Such patients woul benefit from pharmacist care if correct criteria are met eg strong family history And other comorbiditity factors eg High Bp ,high cholesterol and on high dose statins obese to name the main ones. Getting them on metformin would be a safe option after considering patient limiting factors. A chance for every pharmacist to add extra services. Having pts drift at borderline to diabetic range for years is utter stupidity.

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