In 2014, in outlets as diverse as Science 2.0, the Chicago Tribune, American Thinker, and the American Council on Science and Health I began debunking "pre-diabetes" as a fake designation for a non-disease no one else in the world accepts.

I had seen the fuzzy claim that a hemoglobin A1c blood sugar level of 5.7 was a big risk for diabetes gaining in popularity since 2010 but despite concern about its relevance by 2016 our own Centers for Disease Control had created a website with a few simple questions (1) which would lead 86 million Americans to believe they have a disease.

The problem is their threshold was completely arbitrary. Only 5 percent of people who met this dubious blood sugar level ever went on to develop real diabetes, which means it has no clinical value.  And on a survey on a government website there was no evidence they even had a blood sugar level of concern,  yet they were told they do

It was just pathologizing normal human existence. If it were valid, half of China would be "prediabetic."

And yet the American Diabetes Association was able to resist debunking by every international body and get CDC to jump on board. They did it using framing. Though "impaired fasting glucose" and "impaired glucose tolerance" as a way to hype up a slight elevation in blood sugar went nowhere, a marketing session that came up with "prediabetes" paid off. And yet the public had not been helped. Obesity has not gone down, diabetes has not gone down. And CDC is scrambling to rationalize why they turned over their organization, to an outside body which raises money talking about how vital its work is. The answer seems obvious: Ann Albright, PhD, RD, Director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention and who spearheaded this arbitrary a1c metric, was on the Board of ADA.

Though Dr. Albright used to claim that 30 percent of untreated prediabetes patients progress to diabetes within 5 years, which no one could validate, she told journalist Charles Piller for Science, “We no longer use that statement to characterize risk” and refused to go on the record or make her top epidemiologist available either.

It would have ben an awkward conversation, since Piller notes CDC's own data show fewer than 2 percent of those with a "prediabetes" a1c level progress to diabetes each year and, as I noted above, some studies find that it's only 5% during their entire lives.

So CDC no longer uses that statistic, but why did they ever? 

In emails to me defending their belief, CDC stated they wanted to warn people about diet and exercise - the CDC had added "and Prevention" to their mandate - and seemed to think telling Americans they were on the road to insulin shots would cause them to eat less pizza. That may work for 2 percent of people, just like only 2 percent of Americans can follow government guidelines without being miserable, but everyone else is going to want their diet and lack of exercise to be seen as exculpatory - a disease. We have little control over diseases and for diseases we take medication.

At a time when Americans are already suffering double digit health insurance increases with access to fewer doctors, a government agency should not be engaged in medicalization of normal existence. Having up to a third of adult Americans be told on a government website they are at risk for a scary sounding condition is the opposite of what the CDC is supposed to do. 

And what will happen when a patient goes to their physician and is told they don't need medication, they just need diet and exercise, and gets mainstream media attention with claims that doctors, hospitals, and insurers are refusing to treat a condition the CDC says is real? People in Congress are going to engage in political theater, the New York Times will write teary profiles of someone who feels like their diabetes could have been halted if they had got medication when their blood sugar level was lower, sketchy academics will begin pumping out papers finding that, why yes, just as pop media says, prediabetes is a real thing, and health care costs, which are already going up by double digits each year, will balloon ever more.

And no one will be helped.

Meanwhile, China will be scratching its head wondering why Americans think 500 million Chinese with that same A1C level have a disease. 

We can't blame the Obama administration, the Trump CDC has continues those 

(1) "Are you a man or a woman?" "What is your age?" "Are you physically active?" etc. which then computes a 1 to 10 risk of prediabetes. So they are using self-reported answers to an online quiz to calculate risk for being diagnosed with something something that is only a minor risk for a real disease. A shocking waste of government money.

Charles Piller, 'Dubious diagnosis', Science 08 Mar 2019: Vol. 363, Issue 6431, pp. 1026-1031
DOI: 10.1126/science.363.6431.1026

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