Are we over-diagnosing pre-diabetes?

I know that this question has been touched on here-and-there already in this forum, but since I just saw the American Diabetes Association Tweeting about their “risk test” online again, I was curious what everyone here thinks.

If you’re unfamiliar, ADA has a simple test that they publish. After answering a few questions about your weight, height, family history, lifestyle, etc, you receive a score between 1 and 10. The closer to ten, the higher your risk for developing pre-diabetes or type 2 diabetes. This year’s test is at:

Whenever I see ADA promoting this test, I’m reminded of the opening anecdotal story from this talk by John Yudkin on the overdiagnosis of pre-diabetes. The risk test in this video is not by the ADA, but rather by Omada Health, but the concept is the same.

I’m particularly interested to hear the opinions of people that are currently living with type 2 diabetes or pre-diabetes. Were you diagnosed early enough to call it “pre-diabetes”? Do you wish you knew that you were developing diabetes or pre-diabetes sooner or later than you did?

The opinion of the researcher in this video is that we are diagnosing people too frequently. His risk test put him at a “high risk” just because of his age. Do you think that is too alarmist? I think the argument against over-diagnosis (their words not mine) is that if we tell everyone they have pre-diabetes, nobody will take pre-diabetes seriously.



And the counterpoint to that is that when we wake up and realize that’s everyone has a largely preventable disease we might realize that we are doing a thing or two wrong as a society and that we need to take a hard look at what our norms are (normal diet, normal activity, normal fitness, normal weight, normal occupations, etc) and re-evaluate if that’s really still working for us or if maybe we should do some things differently…

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@Sam19 - That’s a great point. If, for argument’s sake, we assume that BOTH sides of the coin are completly incorrect and both sides are overreacting. Which is more dangerous? The side that says, “Slow down, not everyone has diabetes. Let’s not get too concerned!” Or the side that says, “This is an epidemic and we need to make serious changes to make everyone healthier!”

I do also agree that it’s likely overdiagnosed and people with real-deal type 2 diabetes probably have every right to roll their eyes a little every time someone is diagnosed with prediabetes after having a random fasting glucose of 115 or whatever…

I think there is a legitimate difference in having slightly elevated glucose levels (which are still a valid indicator of poor health, but not necessarily of a disease state) and that it’s not always in the best interest to correlate the two 100% of the time. The reality is, many people who do have slightly elevated glucose levels can completely reverse it with lifestyle changes (because it’s not a disease, it’s just an elevated lab reading) whereas people with real diabetes can not…


I’m on the other side of the fence…yes, we need to be aware and pro active…but the medical institution is frankly following the beat of their own drummer for the better part. I have, during the phase that might have been referred to as “pre-diabetic”, been told that 1. there is no such thing…2. that my impaired bg is not pre-diabetic…3. that hypoglycemia cannot possibly be linked to diabetes…4. that a pre-prandial of 8 (in the morning) is not a concern…5. that people who have pre-diabetes cannot possibly go low…and a myriad of other contradictions. One hardly knows where one stands.


Too many adults with Type 1 and LADA are initially misdiagnosed with Type 2.


Answering the original questions.

Nope. It was full blown by the time it was spotted.[quote=“mrmikelawson, post:1, topic:59182”]
Do you wish you knew that you were developing diabetes or pre-diabetes sooner or later than you did?
Hell, yes. The earlier you catch a problem the more you can do about it.

Also, a terse sound-bite version of one of my favorite rants: there is no such thing as “pre-diabetes”. Either the body can regulate its sugar levels without outside help, or it can’t. There is only diabetes, with varying levels of seriousness from almost trivial to severe. “Pre-diabetes” is an artificial angels-on-a-pin construct designed to allow mild cases to be taken less seriously (until they’re no longer mild).


Next thing you’ll be telling me that “sort of pregnant” isn’t a condition either. :slight_smile:


Well, that one’s pretty controversial, I don’t think I’d go that far. :sunglasses:


My diabetes (the type of which is still open to debate…) was full-blown when diagnosed. In my case, an earlier diagnosis of “pre-diabetes” would have done nothing to help me, unless is came when I was quite young. I had already been doing all of the things the medical community would have recommended I do for a Dx of “pre-diabetes” for at least a dozen years before my diagnosis – so there would have been no impact, except increasing my mental stress.

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So, as others have mentioned, I’m not sure it would have affected me much one way or the other. I had non-diabetic (including “prediabetes”) lab results in May 2015 (fasting blood glucose of 85 mg/dL and A1c of 5.6%). In May 2016, I had fasting BG of 185 (or close, don’t remember the exact number) and an A1c of 7.5% (again, may be off by a tenth of a percentage point or two). This led my primary care physician to diagnose me as Type 2, prescribe Metformin, and send me to a diabetes educator. I was 40, overweight (although not overfat), and stressed as hell (new job, kid on the way, just finished my dissertation about 6 months prior).

Since that time, I’ve got some new doctors and a provisional diagnosis as “early LADA progression,” since I have detectable antibodies, don’t appear to be significantly insulin resistant, am short on actual insulin, and can’t stop losing weight (so much for being overweight and being muscular haha). Anyhow, because of the speed with which my quite mild first year of being a diagnosed diabetic came on, I don’t think I would have been able to change much if I’d been diagnosed as “prediabetic.” My doctors are of the opinion that such a thing doesn’t exist: like David, they believe that “prediabetes” is just early Type 1 or Type 2 or MIDD/MODY/etc. before the pancreas and other metabolic-regulating organs are completely dysfunctional.

Honestly, it wouldn’t make much difference to me. My diabetes doesn’t appear to be reversible, which makes sense, so not sure why throwing an extra step in there would have made a difference.

I find this topic interesting. I have no idea why the healthcare positions in this area are so fundamentally messed up and confused. Nobody seems to understand the difference between risk, association and cause. The identification of “risk” factors that are indicative of “pre-diabetes” are symptoms that are observed in people who are known to progress to diabetes. The unfortunate fact is that this “association” has been perverted into a “cause.” This is the basis for the Diabetes Prevention Program (DPP) and ideas like medicating those with “pre-diabetes” with metformin. The real question is whether someone “screened” as having the risk factors of “pre-diabetes” can be treated to avoid “full-blown diabetes.” Unfortunately, that has been a total disaster. The DPP over 15 years showed that lifestyle changes, treatment with metformin and “doing nothing” basically had the same outcome. It didn’t matter. The majority of those who displayed as pre-diabetes become full blown diabetes. And treating it with metformin or lifestyle treatment made no difference in the outcomes.

It is hugely embarrassing to the to see such results. This is why Yudkin argues that screening for pre-diabetes isn’t beneficial. If it doesn’t make any difference, treating with a medication with clear side effects is not a win. But so much has been invested in the DPP and basically ineffective interventions that is really is like shouting in a large room.


To me, this just means the wrong questions are being asked. Maybe the right question is how to we prevent people from developing “pre-diabetes” instead of how do we prevent prediabetes from progressing…

Great question, but that has not been deemed interesting enough to explore. I hope you remembered to donate to the ADA before the year end.

Two years before developing LADA, I was told my blood sugar was “a little high.” I was in my 40s. Scoliosis makes me look fat. Like many others, I was first misdiagnosed T2 and had to fight for the correct diagnosis and treatment.

Elevated glucose levels mean the body doesn’t effectively metabolize carbohydrates. It doesn’t tell why. Testing for autoimmune antibodies and C-peptide will.

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I’m curious what exactly the “lifestyle changes” were.

Most people I know with prediabetes have done nothing and the disease has indeed progressed. However 2 did follow my advice and started a testing program to find out which foods were causing them to spike over 140. They modified their diet to remove or limit the foods causing the problem and so far their disease has not progressed, in fact both have lowered their A1C’s below the prediabetes threshold.

My point is that if the “lifestyle changes” included, for instance, switching to whole grains this may or may not have been the correct dietary intervention for that individual. Only a testing program will tell whether the dietary intervention is working.


The Lifestyle Changes were a low fat high carb calorie restricted diet and exercise. I guess there is some argument about whether a low carb diet would have had better results, but in this case only 1 out of 14 lifestyle arm participants did better than participants who “did nothing.”

I agree with you 100% that this will not be effective at preventing progression. This does not demonstrate at all that progression can not be prevented though.

Pouring gasoline on a fire in an attempt to put it out does not prove that a fire can not be extinguished with water…

It’s the wrong intervention…

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One of my examples was living what I would call a health conscious lifestyle. Plenty of exercise, a low fat mostly vegetarian diet, very few saturated fats etc. In other words she lived the lifestyle changes advocated in the study for most of her life. Yet over the years her A1C was slowly creeping higher. When she tested she found she was regularly spiking to 180 and even over 200 for a particularly carby meal. Since modifying her diet her A1C is slowly heading in the other direction.

The advantage of confronting prediabetes early is that the dietary intervention will be much less drastic than what is required for out of control full blown diabetes.

Of course this is strictly anecdotal evidence and the time frame is much less than 15 years. In any event the vast majority of people are not interested in giving up some of their favorite foods.

Still I wish people would be given this option because a few of them will adopt this approach and I believe it will help at least slow the progression of the disease.


I “progressed” on a paleo LCHF, and towards the end ketogenic, diet with lots of exercise. Started at diagnosis of 10.7, then with extreme effort kept it between 5-5.6 for 2 years and then slowly worked my way over the next 3 years to being very much insulin dependent. I don’t have GAD antibodies, but my c-peptide has been going down year-over-year.

I feel like a giant :poop: when I hear that I was supposed to be able to prevent or slow the progression with the right “lifestyle” changes.

Rather than worrying about whether we should tell people when things aren’t looking right, I wish that we would instead focus on how to help the people who have been diagnosed. I would have really appreciated knowing that progression is a thing to be expected, how to spot it, when to admit that herculean diet/exercise interventions aren’t enough and always have the option to take insulin when I felt ready.