The American Diabetes Association (ADA) disagreed, saying that risk needs to be identified.
“The risk that an adult has prediabetes or diabetes is in fact very high in the U.S. population,” said Dr. Robert Ratner, the ADA’s chief scientific and medical officer. “The goal of a free screening tool is to identify reasonable risk while missing as few people as possible,” he said.
The ADA recommends everyone with prediabetes engage in lifestyle changes to reduce their risk. For some patients, the ADA also recommends use of the drug metformin, which Ratner said is very inexpensive, safe and ultimately cost-saving.
The new analysis is the latest barb in a larger, prickly debate over what cutoff points to use in defining the risk for progressing to diabetes. Should it be an impaired fasting glucose level of 110 milligrams per deciliter (mg/dL) of blood, as the World Health Organization defines it? Or is the ADA’s 100 mg/dL a better measure?
Placing millions of U.S. adults into the prediabetes category “is diluting the risk substantially,” said Dr. John S. Yudkin, emeritus professor of medicine at University College London in England.
The online prediabetes assessment asks people to rate their risk based on seven questions, including a person’s age, gender, family history of diabetes, activity level and weight.
People who score 5 or more on the test are deemed likely to have prediabetes or a high risk for type 2 diabetes. Individuals in the high-risk category are urged to talk to their doctor.
The Tufts researchers, whose work involves assessing the benefits and harms of different health interventions, calculated the prediabetes risk in the U.S. population using nationally representative health data.
Because the online questionnaire puts such a vast swath of the population at risk of prediabetes, Shahraz said, the test results overstate the risk. In his view, it’s a “false positive.” And that may be driving unnecessary worry and use of medical resources, he added.
“What we can say for sure is we need longer term studies to show the benefits before we widely recommend any medical treatment for these patients,” he said.