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"Pre-diabetes" - preventative medicine or lazy science?

Answered on August 19, 2014
Created March 07, 2012 at 5:57 PM

Sorry...I know it's not as simple as that, I'm just frustrated with a conventional medical model in which a number on a report defines a person's state of health and generates a prescription.

My mother was just diagnosed as "pre-diabetic". Her family doc told her she was, and her endocrinologist confirmed it today. Both have prescribed blood pressure meds and statins to "protect her arteries". Problem is, she's pretty f***ing healthy! At least I think so:

  • 67 years old, looks about 55.
  • 5'2", 117 lbs - muscular and lean.
  • Weight training 3 times a week, walks daily.
  • SAD diet but mainly whole foods, almost zero junk.
  • Blood pressure: low normal when at home, slightly elevated when taken by the doc.
  • Cholesterol: excellent HDL-LDL ratio, LDL "a little higher than we like to see".
  • Blood glucose: tracked it daily for 2 months - 70-80 consistently.
  • Last two A1C results: 5.1 (104 mg/dL).

Confounding factors:

  • She has fairly aggressive osteoporosis and takes Fosamax for the bone loss.
  • She has hyperparathyroidism (thyroid radiated as a kid).

Her "pre-diabetic" diagnosis was based on two failed glucose tolerance tests - by "failed" I mean when they tested her BG, it was too high (126) to complete Step 2 of the test. Doc says two failed tests = prediabetes.

What the f**k?! She walked into the appointment with nearly 200 data points and the diagnosis was made based on 2 outliers. Am I wrong to think this is a bad diagnosis? Statins...really?!

Can someone help me get my head around this? She has an appointment on Monday and will be told she has to take these pills or else. Should I intervene and try and convince her to hold off?

3846a3b61bc9051e4baebdef62e58c52

(18635)

on March 08, 2012
at 11:28 PM

They seem to hold this cultural authority over elderly folk more. The younger generations know how to google or use websites like these to get a grip on what is happening and recognize that their Dr. is just one opinion.

Medium avatar

(3259)

on March 08, 2012
at 02:20 PM

She doesn't feel she's pre-diabetic at all. She also, unfortunately, is afraid to challenge her doc, who she's been with for 25 years. She says she "hopes she can convince him". I say "It's your body - he can't "tell" you to do anything!". How did these doctors amass such power over people?!

96bf58d8c6bd492dc5b8ae46203fe247

(37227)

on March 08, 2012
at 01:13 AM

I have "white-coat" syndrome so they always get high bp readings for me but I took my own cuff, which got the same readings, and then I showed them the normal readings I get at home. I guess that's common.

6120c989fd5b69f42a0834b69b87955b

(24553)

on March 08, 2012
at 12:44 AM

I guess metformin wasn't the best example for T2D meds here, it is on the cheap end, just the one I'm most familiar with. I do think doctors get inundated with drug ads and samples though, and tend to write prescriptions based exclusively on what drug companies publish.

A727956fa3f943057c4edb08ad9e864e

(4183)

on March 08, 2012
at 12:29 AM

No one makes much money from selling metformin, it's generic.

3846a3b61bc9051e4baebdef62e58c52

(18635)

on March 07, 2012
at 07:25 PM

That and I think it was Catherine Shanahan that did a piece on the perils of fosfamax at the paleo summit. Might wanna look up some on that subject too.

B0fe7b5a9a197cd293978150cbd9055f

(8938)

on March 07, 2012
at 06:23 PM

What does your mother say herself?

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4 Answers

4
4815ce60a36f08fb6878bb458c249034

on March 08, 2012
at 12:42 AM

This doesn't sound like pre-diabetes. Gtt should be over 140 at 2 hours or fasting over 125 or a1c over 6.4. She has really good numbers.

If I have people bring a bp log with good numbers from home, I will ignore borderline numbers in the office. I would probably recheck the bp a few times in the office with a manual cuff.

Total/hdl ratio is what I would look at. Maybe get a crp and vap, not really that necessary with her numbers. What is family history like? Smoker? Vit D? Guessing about some of her numbers based on the information you gave would give her a Framingham 10 year risk of heart disease at 2% (I assumed total chol under 240, hdl over 60 and systolic bp under 130). Even 10 years older her risk only goes up to 5% with those numbers.

Sounds like the osteoporosis is her biggest concern.

96bf58d8c6bd492dc5b8ae46203fe247

(37227)

on March 08, 2012
at 01:13 AM

I have "white-coat" syndrome so they always get high bp readings for me but I took my own cuff, which got the same readings, and then I showed them the normal readings I get at home. I guess that's common.

3
6120c989fd5b69f42a0834b69b87955b

(24553)

on March 07, 2012
at 11:46 PM

How topical, my mom and I were just discussing this yesterday. Apparently, it was just changing the stats based on drug company recommendations that we now have the "need" for statins in healthy people because the number for high cholesterol was reduced from 260 to 200. Pre-diabetes is a convenient diagnosis to sell more diabetes controlling medications like Metformin for people who have a blood sugar over 100 (used to be 130 was the cut off). Not to be all cynical and paranoid, but these are both manufactured illnesses to sell more drugs from what I can tell.

I think your mother would be well served by cancelling her upcoming appointment, and sending a note to her current physician with something along the lines of, "Sadly, I feel that my medical needs would be better served by someone who actually understands how the human body works, rather than relying on information provided by those who stand to profit from selling prescriptions."

6120c989fd5b69f42a0834b69b87955b

(24553)

on March 08, 2012
at 12:44 AM

I guess metformin wasn't the best example for T2D meds here, it is on the cheap end, just the one I'm most familiar with. I do think doctors get inundated with drug ads and samples though, and tend to write prescriptions based exclusively on what drug companies publish.

A727956fa3f943057c4edb08ad9e864e

(4183)

on March 08, 2012
at 12:29 AM

No one makes much money from selling metformin, it's generic.

2
13c5a9f1678d75b93f269cdcf69f14d5

(2339)

on March 07, 2012
at 08:09 PM

NNT for primary prevention with statins:

http://www.thennt.com/statins-for-heart-disease-prevention-without-prior-heart-disease/

Heart disease risk rises linearly after an A1c of 5.5. She's doing just fine, but details here: http://www.phlaunt.com/diabetes/15945839.php

2
D31a2a2d43191b15ca4a1c7ec7d03038

on March 07, 2012
at 06:17 PM

Riveted, Dr. Richard Bernstein's book, The Diabetes Solution, will give you enough information to make some good choices.

He is the diabetes expert.

All the best to you. :)

3846a3b61bc9051e4baebdef62e58c52

(18635)

on March 07, 2012
at 07:25 PM

That and I think it was Catherine Shanahan that did a piece on the perils of fosfamax at the paleo summit. Might wanna look up some on that subject too.

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