Value of Risk Assessment Tool for Prediabetes Questioned

According to a research letter published in JAMA Internal Medicine, the application of a popular web-based risk assessment tool for prediabetes categorizes a majority of adults aged 40 years and older at high risk for the condition. However, the researchers questioned whether the “medicalization of prediabetes” may be problematic.

Saeid Shahraz, MD, PhD, of Tufts Medical Center in Boston, and colleagues examined data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) to calculate risk for prediabetes based on 7 questions that closely mirrored those found on the web-based risk assessment tool endorsed by the US Centers for Disease Control and Prevention, the American Diabetes Association (ADA), and the American Medical Association. Questions addressed age, sex, family history of diabetes, history of gestational diabetes, history of hypertension, physical activity, and weight.

Complete information was available for 96.5% of the 10,175 participants.

According to results using the risk assessment, 58.7% of US adults aged 40 or older (sample size for age group, 3815; 95% CI, 56%-62%), are at high risk for prediabetes. For those aged 60 or older, 80.8% were at high risk for prediabetes (sample size for age group, 1841; 95% CI, 78%-84%). Confirmation through a medical visit and blood glucose test are required, the researchers noted.

“Given the expanded criteria, many of these high-risk individuals will have prediabetes when tested. However, such a widespread process may be premature for many reasons,” they wrote.

For instance, the researchers noted that the US Preventive services Task Force cites a lack of direct evidence between prevention of type 2 diabetes and risk for diabetes-related complications. They also stated that the natural history of prediabetes based on the most recent ADA criteria has not been studied prospectively, but “it is likely progression to type 2 diabetes will be slower with the expanded criteria compared with impaired glucose tolerance.”

Additionally, the researchers pointed out that classifying so many people as being at risk for prediabetes may have other drawbacks.

“Finally, medicalization of prediabetes may have the unintended consequence of reducing health care access to patients with type 2 diabetes and other chronic conditions,” they wrote. “A valid method to examine for prediabetes should avoid unnecessary medicalization by labeling a disease predecessor as a medical condition and seek to concentrate on people at highest risk to allow for efficient distribution of limited health care resources.”

Disclosures: The researchers report no conflicts of interest.

Reference

1. Shahraz S, Pittas AG, Kent DM. Prediabetes in Americans according to a risk test [published online October 3, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.5919.