{"id":6539,"date":"2021-05-11T07:06:02","date_gmt":"2021-05-11T11:06:02","guid":{"rendered":"https:\/\/www.silvercentury.org\/?p=6539"},"modified":"2021-05-11T19:36:03","modified_gmt":"2021-05-11T23:36:03","slug":"a-diagnosis-in-search-of-a-disease","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2021\/05\/a-diagnosis-in-search-of-a-disease\/","title":{"rendered":"A Diagnosis in Search of a Disease?"},"content":{"rendered":"

Back in 2016, my doctor told me I was prediabetic: my blood sugar level was above normal, and if I didn\u2019t do something about it, I could wind up with type 2 diabetes. That scared me. I know what a dreadful disease diabetes can be when it gets out of hand. <\/span><\/p>\n

I took the diagnosis seriously, but now I\u2019m questioning that, thanks to a study of older people, published recently in <\/span>JAMA Internal Medicine<\/span><\/i>. Its results suggest that, in focusing on prediabetes, health authorities may be medicalizing a change in blood glucose (blood sugar) that\u2019s usually just a normal result of aging.<\/span> <\/span><\/p>\n

The suggestion that something may have been \u201cmedicalized\u201d always grabs me, because decades ago when <\/span>normal menopause was medicalized<\/span><\/a>\u2014redefined as a disease that needed treatment\u2014I took estrogen for years, like millions of other women. It wasn\u2019t until 2002 that a huge study revealed the risks we all ran from being treated with female hormones.  <\/span><\/p>\n

In the prediabetes study, the researchers tracked the blood sugar levels of more than 3,400 individuals between the ages of 71 and 90. None of them had diabetes when the research began, but almost three-quarters were <\/span>pre<\/span><\/i>diabetic, meaning their blood glucose levels were higher than normal but not high enough to indicate they had diabetes. (Three-quarters isn\u2019t an uncommon finding.) <\/span><\/p>\n

Half a dozen years later, fewer than 10 percent of the study\u2019s subjects had developed diabetes, while for a much larger number, blood sugar readings had dropped back to normal. Research on older people, done in Sweden, reported similar results. <\/span><\/p>\n

That made me wonder about my own diagnosis. I did a bit of googling and learned that in later life, the pancreas ordinarily produces less insulin and the body becomes more insulin-resistant. (Insulin is a critical factor in moving glucose from the body\u2019s bloodstream into its cells.) When there\u2019s too little insulin, there\u2019s too much glucose in the blood. <\/span><\/p>\n

I also learned that most previous research on prediabetes didn\u2019t focus on older people like me\u2014which suggested that earlier evidence, showing that a significant number of those who are prediabetic go on to develop full-fledged diabetes, may apply mainly to the middle-aged. <\/span><\/p>\n

But it turns out that prediabetes is actually a controversial diagnosis for those of all ages. The term was chosen by the American Diabetes Association (the ADA) in 2001, apparently because it was scarier\u2014and more likely to motivate patients\u2014than telling them they had \u201cimpaired glucose tolerance.\u201d<\/span><\/p>\n

In the years that followed, some critics objected that the parameters for prediabetes were arbitrary to begin with, and that in 2010, the ADA moved the goalposts. <\/span><\/p>\n

Testing for hemoglobin A1c is the easiest way to measure glucose in the bloodstream. <\/span><\/p>\n