The Lie That’s Killing Us: Pre-Diabetes

By Riva Greenberg

Pre-diabetes is a lie. Pre-diabetes is Stage 1 diabetes. And I’m taking a stand now advocating that we call it what it is.

Pre-diabetes doesn’t exist. And the lie we tell that it does does incredible harm. It stops the nearly 80 million Americans we say have it from making the lifestyle changes necessary to prevent advanced Type 2 diabetes. Pre-diabetes is in truth the first stage of diabetes.

My proposition is that recognizing pre-diabetes as “Stage 1” Type 2 diabetes will get millions more people to take action to stop their diabetes from progressing.

About 80 million people is roughly the populations of California, Texas and New York combined. The International Diabetes Federation reports that in 2011, 280 million people worldwide were glucose intolerant (pre-diabetic). In only 17 years, 398 million people will be.

We clearly need a new strategy. The 25-year campaign the American Diabetes Association has waged to raise awareness of diabetes and pre-diabetes and urge preventive and healthful behaviors has been sadly, and enormously, unsuccessful.

Pre-Diabetes Is Stage 1 Diabetes
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Pre-diabetes literally says you don’t have diabetes — but you do. Your blood sugars are higher than normal, a defining characteristic of diabetes.

A study performed at Crittenton Hospital Medical Center in Detroit showed 36 percent of people with pre-diabetes already had coronary artery disease, similar to the 42 percent with Type 2 diabetes and strikingly higher than the 21 percent with normal blood sugars. Higher than normal glucose levels impact hypertension (high blood pressure) and lipids like cholesterol and triglycerides. Plus, most people with pre-diabetes show signs of retinopathy (eye damage), nephropathy (kidney damage) and neuropathy (nerve damage), all diabetes complications.

Lynda Sardeson, a certified diabetes educator and registered nurse, wrote to me in an email, “We began diagnosing pre-diabetes and put it in practice guidelines around 2004 to try and ‘catch’ those with diabetes earlier to prevent more complications.”

Exactly: “To catch those with diabetes earlier…” So let’s call pre-diabetes what it is: Stage 1 diabetes. Why? Because it is. Because health care providers need to take it seriously and not soft pedal it. Because policy makers must decrease the health care costs of diabetes now poised to bankrupt us. Costs have risen $70 billion in the past five years with no end in sight. Last year the U.S. spent $245 billion health care dollars on diabetes — the total GDP of Israel.

And, because for patients, hearing you have Stage 1 diabetes, like hearing you have Stage 1 cancer, has power and hope in it. The power of alarm to motivate behavior change — and the hope of remission if you do.

Four Stages of Type 2 Diabetes