Pre-Diabetes: Epidemic or False Alarm?

May 12, 2016

Are efforts to enhance public awareness of the risk of prediabetes overkill, just right, or just not enough?

How aggressively should we as a society and you as a physician educate and warn?

Eighty-six million Americans are at risk of developing diabetes, but 9 out of 10 individuals aren’t even aware of this danger. These alarming statistics are estimates from the Centers for Disease Control (CDC). I won’t delve into the debate about whether we should even consider this as a condition, as some have argued against. What’s new in the efforts to enhance public awareness, and how are some reacting?

A joint campaign - Earlier this year, the American Diabetes Association, the CDC, and the American Medical Association joined forces with the Ad Council to produce the first national public service advertising campaign on prediabetes. Check out the ads here: http://www.adcouncil.org/Our-Campaigns/Health/Type-2-Diabetes-Prevention. “For the 86 million Americans with prediabetes, we need to communicate a sense of urgency -- that it’s time to take action,” said Ann Albright, PhD, RD, director of CDC’s Division of Diabetes Translation.1 “By participating in a CDC-recognized diabetes prevention program, people with prediabetes can learn practical, real-life changes and cut their risk for developing type 2 diabetes by 58 percent.”

“With this campaign we are hoping to spark a change because the reality is that the majority of the public is either unaware or does not take prediabetes seriously,” said Corinna Falusi, Chief Creative Officer at Ogilvy & Mather Advertising New York.1 “We created the real-time test, which is the first of its kind and addresses people’s naivety of prediabetes, allowing prediabetes tests to be conducted in a 60-second TV commercial. Instead of educating the viewer in that 60-second spot, we are pushing them to take action in the moment and get results from that action.”

But not everyone applauds this effort. Victor Montori, MD, an endocrinologist at the Mayo Clinic, has raised concerns. “The problem with that definition is that it includes too many people, and the problem with including too many people is that the proportion of those people who will then go on to develop diabetes is actually very small - in the order, perhaps, of 2 to 3 percent over the course of three to five years.” He also noted, “...if the problem affects one in three Americans, is it possible that diabetes is not the result of poor individual decision-making or poor individual habit choices, but rather the society that we are building?”2

I would argue that we often don’t spend nearly enough time, money (whether in delivering health care, or in research grants), or energy thinking about or talking about prevention of diabetes or of other diseases. I would suggest we should focus on both individuals and our wider society, and how we all regard illness and health. After all, health isn’t merely the absence of disease.

There are no easy solutions. Yet, we must collectively and continually reexamine and take action on emphasizing how the seemingly small actions we take (or don’t) - as individuals, as communities, as health care systems, as nations - every day can, over time, make the greatest difference.

 

References:

1. Centers for Disease Control. First-of-its-kind PSA campaign targets the 86 million American adults with prediabetes. Jan 21, 2016. http://www.cdc.gov/media/releases/2016/p0121-prediabetes.html. Accessed Apr 10, 2016.

2. Perry S. CDC's new 'pre-diabetes' campaign is misguided, Mayo physician says. MinnPost. Feb 8, 2016. https://www.minnpost.com/second-opinion/2016/02/cdcs-new-pre-diabetes-campaign-misguided-mayo-physician-says. Accessed Apr 10, 2016.