I don’t have what you have – the perils of pre
Yesterday the Centers for Disease Control and Prevention (CDCP) announced diabetes now affects nearly 24 million people in the United States, an increase of more than 3 million in approximately two years, according to new 2007 prevalence data estimates. They further stated “In addition to the 24 million with diabetes, another 57 million people are estimated to have pre-diabetes, a condition that puts people at increased risk for diabetes. Among people with diabetes, those who do not know they have the disease decreased from 30 percent to 25 percent over a two-year period.”
While it would be easy to pontificate on how this growing patient population can be seen as both good and bad. (Good from the business perspective, a growing customer base. Bad for a wide range of reasons, not the least of which being the economic consequences and strain to our healthcare system.) Believe it or not there is actually a bigger problem on the horizon, a problem that’s hidden from view but becoming larger each day.
A few years ago Diabetic Investor speculated that in an effort to expand the market for diabetes medications the industry would actively promote this new condition called pre-diabetes. The industry just wasn’t content to have a diabetes epidemic they figured their share prices would increase when investors realized that the market wasn’t limited to the 24 million with actual diabetes. The market was actually near 100 million patients when you include the 57 million consumers with “pre-diabetes.”
Today you can’t swing a dead cat without hearing the term “pre-diabetes” and not just from companies in the drug business. Researchers and physicians have embraced this new condition as well. Physicians are now diagnosing patients with “pre-diabetes” and prescribing medications to prevent the patient from developing full blown diabetes. As well intentioned as these efforts are to prevent patients from developing full blown or real diabetes, this fascination with “pre-diabetes” has created an even bigger problem. Diabetic Investor calls this problem the “I don’t have what you have” syndrome.
Simply put patients diagnosed with “pre-diabetes” don’t believe they actually have anything to worry about. They fully acknowledge that “real” diabetes is a problem but that’s not what they have. Diabetic Investor has experienced this syndrome firsthand and believes that the term “pre-diabetes” will end up doing more harm and NOT prevent anything. Patients diagnosed with “pre-diabetes” interviewed by Diabetic Investor (realizing that I have “real” diabetes) state consistently “I don’t have what you have.”
To Diabetic Investor “pre-diabetes” is like a woman being sort of pregnant. Either you have diabetes or you don’t. The fact that the popularity of “pre-diabetes” has taken hold is further confirmation that the people who are supposed to be helping deal with the diabetes epidemic have lost touch with the real world. Why is it that we cannot have a clear cut distinction between what diabetes is and what it isn’t? Why would anyone take seriously a condition they don’t have? What reason do they have to test their glucose levels or stay compliant with their medication? After all they don’t really have diabetes.
The term “pre-diabetes” is one of dumbest ideas perpetuated right up there with the other great stupid idea to stop using a simple number to measure control. Diabetic Investor has previously reported on the attempt to replace HbA1c as the standard for defining control. Instead of reporting HbA1c results a move is underway to use a new number called estimated average glucose (eAG). Never mind that HbA1c is THE easiest number of all to understand for both patients and physicians and that eAG only adds yet another confusing number to the mix.
It’s bad enough that patients don’t receive the education they need to understand what their glucose levels mean and how to use this data to more effectively treat their diabetes. If these idiots have their way these under-educated patients will have yet another number they don’t understand. To illustrate just how nutty this whole situation is consider what David M Nathan, MD, Professor of Medicine, Harvard Medical School and co-chair of the International A1C-Derived Average Glucose (ADAG) Study said, “While eAG will not replace A1c, physicians will be able to obtain reports both in A1c units of glycated hemoglobin and eAG units of milligrams per deciliter or millimols per liter, depending on the country, and chose which to use in clinical situations.”
Someone needs to explain to Diabetic Investor, the millions with diabetes and the physicians who treat them the need for eAG. If eAG is not a better measurement why use it at all. Using eAG at all is like replacing long held standards when measuring blood pressure or cholesterol with new numbers that measure exactly the same thing only in a different format. The fact is eAG adds no value whatsoever and should be dismissed for what it is; one of the dumbest ideas to hit diabetes. That is, of course, until another dumb term like “pre-diabetes” came along.
The term “pre-diabetes” and eAG remind Diabetic Investor of something Walter Bagehot wrote in a letter to the London Inquirer back in 1851, “Stupidity …. is nature’s favorite resource for preventing steadiness of conduct and consistency of opinion.”
When will this madness end?