If you find the term “pre-diabetic” confusing, then prepare to be confused some more. Pre-diabetes was coined at the turn of the millennium by the American Diabetes Association as a user-friendly way of describing someone not definitely about to develop diabetes but considered to be at risk, based on measuring their average blood glucose concentration.
While the term is used in the UK and US, it’s been rejected by the World Health Organization (WHO) and criticised by some scientists. The journal Science now reports that even some people who helped create the term “pre-diabetic” are concerned about it.
The criticism includes it making patients of healthy people – leading sometimes to treatment they may not need, and problems with employment and insurance (in the US). There’s concern about thresholds for glucose levels being set too low (the ADA lowered its own threshold in 2010), producing more pre-diabetics. There is also concern about how few (particularly low-threshold) pre-diabetics are known to progress to diabetes. Then there are the potential conflicts of financial interest, with pharmaceutical companies predictably highly motivated to develop drugs for this huge market… and on it goes.
At which point, you may be thinking, what’s all this got to do with my friend/parent/grandad being told they’re pre-diabetic, and advised to lose weight and exercise? Some might say the pre-diabetic diagnosis is a useful wake-up call, particularly in an era of rising obesity, for people to make lifestyle changes. All people have to do is lose weight to help reverse their pre-diabetic diagnosis, and improve general health. However, it seems that, far from being simple, it’s a deeply complex scientific – and social –ding-dong.
This goes way beyond individuals following, or not following, advice to lose weight – into looking at wider society, and how conditions are created for diabetes to thrive. The WHO, among other groups and experts, prefers societal solutions to diabetes prevention – encompassing everything from food regulations to taxation to failures in urban planning. So, rather than “let’s focus on obese people, and look into preventing the diabetes they may or may not develop”, it becomes “let’s first look into the societal conditions leading to widespread obesity, and, by doing so, help prevent diabetes”.
This could encompass anything from the food companies that still get away with producing unhealthy products to the much-trumpeted sugar taxes that fell short, to the reports about poorer areas (and their schools) having relatively more fast food shops, to stressed parents in insecure work not being able to feed their families as healthily as they’d like, and more.
So, yes, again, it’s very complicated. Basically, our society is itself a significant factor in people becoming obese, and obese people sometimes develop diabetes. Who’s developing a pill for that? And what happens when people told to lose weight to stave off diabetes return to a world that’s rigged for them to fail? While the pre-diabetes debate looks set to rumble on, it would seem that wider society also needs a wake-up call.
• Barbara Ellen is an Observer columnist
