An Enormous Public Health Problem

Over 20 million Americans are known to have diabetes mellitus. This is nearly 7% of the US population. Another 6-7 million people living in the US are also diabetic but do not know it — it has not been diagnosed or even recognized — and thus is not managed in any form. Astonishingly, approximately 60 million individuals in the US have prediabetes, which is a distinct and authentic metabolic disorder that easily and often progresses to the overt diabetes condition. The prevalence of both conditions grows yearly, but the majority of individuals with either condition are not diagnosed.

Around the world, the number of people with prediabetes approaches 350 million. Public health experts predict this number will pass 400 million by 2020. In past years, prediabetes was not recognized but was simply acknowledged as impaired fasting glucose, or glucose intolerance. Glucose intolerance was most frequently minimized as a concern. Folks were told simply to reduce sugar intake and to try to lose a few pounds — or not told anything. However, we now know that the “glucose intolerant condition” — or what we now formally name “prediabetes” — shall progress to overt diabetes mellitus at the rate of approximately 5% per year. That is precisely why “glucose intolerance” has been renamed “prediabetes” and is recognizable as a distinct metabolic disorder worthy of a precise clinical name.

Annual physical examinations with annual blood test screening of at-risk individuals is essential.

The formal definition of diabetes has been tightened because prior criteria were too vague. Frank or overt diabetes mellitus is defined a fasting plasma glucose of 126 mg/dl OR hemoglobin A1c value greater than 6.5%, Prediabetes is defined as fasting glucose of 100 – 125 mg/dl OR hemoglobin A1c value between 5.7 and 6.4%.

These definitions are agreed upon by Consensus Expert Panels globally. Of course, adjusting the definitions to these precise criteria will result in percentage increases in the prevalence of either condition. But, the reasons that Consensus Experts agreed upon these definitions center on the fact that these definitions declare true metabolic abnormalities — true deviations from physiological normals. And, these distinct deviations from metabolic normal have progressive, adverse personal health consequences.

So, public health and personal health data do exist that expose the truth. Prediabetes is a personal threat and a public health problem. It can and will progress to overt diabetes as defined. And, both conditions are linked directly to blood vessel disease, heart disease, kidney disease, and neurological disease. The threat is the glucose molecule. Prediabetes must be recognized, diagnosed, discussed, and managed as the true threat that it is.

Rex L Mahnensmith, M.D. is a concerned Internal Medicine physician who has special interests in preventative care, metabolic disorders, and personal wellness.