Talk:Prediabetes

Recent Task Force recommendations

link --Steven Fruitsmaak (Reply) 18:34, 24 July 2008 (UTC)

The proper term should be Pre-diabetes. Both WHO and ADA use the spelling Pre-diabetes

Parts of this article need editing for grammar and sentence structure; e.g. 'Smoker can plan to quit' and 'Stress causes hormonal imbalance and prevents insulin to work normally and end up with a diabetes. So take the stress seriously and try to be calm or practice meditation'.50.10.99.70 (talk) 03:19, 21 May 2011 (UTC)

Merge with Pre-Diabetes

Agree A merge of the two articles and a redirect are in order. It doesn't much matter which article contains the redirect and which contains the content, as both routes will get a user to the right place. The article can note the generally-accepted spelling, and any variants. --SV Resolution(Talk) 16:53, 6 November 2008 (UTC)

Since Pre-diabetes didn't cite any sources, I simply redirected it here. Its history is still available at [1] in case anyone wants to scavenge useful info from there and add it here - but with sources please! —Angr 15:23, 11 March 2009 (UTC)

References

EDITING OUT LOW-CARB DIET

Hi, I'm an MD with prediabetes/borderline diabetes. For over a year I was able to reduce and stabilize my sugar levels at the low prediabetes levels with a simple lowering carbs in my diet. There are lots of peer-reviewed papers documenting that in the literature. When I came across this wiki page I noticed lack of info on low-carb diet. Interestingly, minutes after I wrote a couple of sentences, the info was deleted by user Piano non troppo who stated that "external links you added to the page Prediabetes do not comply with our guidelines for external links". I reviewed the guidelines, and there was no problem with my link. I feel that there is some sort censorship going on with this page. This reminds me the Wiki fiasco with naked short editing. Nevertheless, I feel that the information on low-carb approach is too vital for too many people with DM or prediabetes, to play some ego games on this page. So, the question is should the low-card info be suppressed here, even though ADA just sanctioned that too? —Preceding unsigned comment added by 68.63.17.138 (talk) 05:29, 28 November 2008 (UTC)

Please do write about the low-carb diets you favor, and present authoritative primary references from peer-reviewed sources to support the statement that these diets have been clinically proven to be more efficacious than the SAD or ADA diets. You already know how to find these articles through a pubmed search. Some may be free to read online, some may be in medical journals you may already subscribe to, and you may have to visit a university library to read some. You can leave it to other writers to supply information about other types of diets (South Beach or Neal Barnard's diet, for example), that have also been shown to be efficacious. Remember to use primary sources, like peer-reviewed papers wherever possible. Summaries at medscape make good "external reference" links for readers who don't have access to the original papers.

Be bold. Cite primary sources. Make a great article. --SV Resolution(Talk) 21:51, 5 December 2008 (UTC)

Definition of Impaired fasting glycaemia

In the last paragraph under Classification ==> Impaired fasting glycaemia, the text describes upper limits of 110 and 100 mg/dL under two criteria while the detail below lists these values as lower limits. This inconsistency is repeated in the Wikipedia article Impaired fasting glycaemia. — Preceding unsigned comment added by 71.185.153.122 (talk) 19:36, 19 August 2012 (UTC)

Definition of prediabetes?

Is there a generally accepted medical definition of prediabetes? The Diagnosis section identifies three blood tests each with a range of readings, then states "Levels above these limits would be a diagnosis for diabetes." Above all of these levels or above any one?

Additionally, it might be useful to explain the connection between the two sets of symptoms in the Classification section and the definition of prediabetes. Currently it's not clear. — Preceding unsigned comment added by 71.185.153.122 (talk) 20:23, 19 August 2012 (UTC)

Signs and Symptoms section - weight gain?

I'm learning about prediabetes, so checked out WP as one stream of information. I notice that under the signs and symptoms heading, weight gain is given. The Mayo Clinic page given in the reference says that one should be screened for prediabetes if one has PCOS, and a symptom of that is weight gain. Therefore, I think it's misleading to suggest that weight gain is a symptom of prediabetes. Diabetes.org.uk says that weight loss is a symptom of diabetes, but I haven't yet found a reference to weight gain or loss for prediabetes.

Would someone please confirm whether weight gain is a symptom of prediabetes (without also having PCOS)? I don't want to edit the page until someone with more knowledge and accurate citations has a look. Thanks MarpoHarks (talk) 19:37, 16 November 2015 (UTC)

Signs and symptoms, blood pressure

Why are elevated blood pressure, and hypertension, both listed? Isn't that the same thing? Dawei20 (talk) 16:36, 22 June 2016 (UTC)

No, they are not the same thing. Hypertension and high blood pressure is the same thing, but you can have elevated blood pressure but not have hypertension. --Frmorrison (talk) 14:35, 24 June 2016 (UTC)

Disease-mongering

There is a singificant viewpoint that pre-diabetes is a meaningless condition created by pharmaceutical companies, among others, to promote treatment with their drugs. I would think that this viewpoint should be included in the article. For example:

http://www.bmj.com/content/349/bmj.g4485
Analysis Too Much Medicine
The epidemic of pre-diabetes: the medicine and the politics
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g4485 (Published 15 July 2014) Cite this as: BMJ 2014;349:g4485
John S Yudkin, Victor M Montori

Diagnostic change—The definition of people at risk has expanded from impaired glucose tolerance to include people with raised fasting glucose or glycated haemoglobin (HbA1c) concentrations and cut-off points have been lowered

Rationale for change—People in all the above categories have a raised diabetes risk, although prediction is poorer for fasting glucose and HbA1c than for impaired glucose tolerance

Leap of faith—Treatment of people in newly defined categories will improve mortality and morbidity

Limitations of evidence—No studies have examined the effect of lifestyle or drug interventions in newly added subcategories

--Nbauman (talk) 01:22, 19 July 2016 (UTC)

Management of prediabetes

The US Food and Drug Administration just issued a qualified health claim that limited evidence suggest that resistant starch reduces the risk of type 2 diabetes. Numerous clinical studies reported improved insulin sensitivity. This evidence was reviewed over 21 months by the FDA and a decision was announced. It is relevant information as the FDA is responsible for the evaluating the quality of evidence for statements on disease conditions. This information has been removed twice citing a need for secondary source to establish weight. This does not make sense - the FDA is the authority on this information and has made their ruling. These types of qualified health claims were established after the FDA lost a major lawsuit stating that they could not prohibit the communication of valid and not misleading information. Prohibiting the communication of this official declaration by the FDA is unwarranted.RSWitwer (talk) 12:54, 16 December 2016 (UTC)

References

You added this same content at Resistant starch too. It is probably undue here, as it's very peripheral to the topic of prediabetes. But the big problem here is that the addition makes it sound like the FDA is announcing some kind of breakthrough. The source is a letter in response to a company wanting to say that resistant starch "may" reduce the risk of type 2 diabetes, with the FDA saying NO you need to qualify such claims with a statement that the FDA considers evidence for this to be limited. Alexbrn (talk) 13:16, 16 December 2016 (UTC)

Thanks for your comments - then the language entered here should be changed to properly reflect the level of evidence instead of eliminate it entirely. I do not want to portray the FDA announcement as more than it is - but it is imnportant that a thorough FDA review concluded that some credible scientific evidence exists that resistant starch improves insulin sensitivity and "may" reduce the risk of T2D. Should I draft another version to consider reflecting this? RSWitwer (talk) 13:58, 16 December 2016 (UTC) How about "According to the FDA, limited scientific evidence has shown that resistant starch from high amylose maize starch improves insulin sensitivity and may reduce the risk of type 2 diabetes. In their December 2016 approval of a Level “C” qualified health claim, the FDA concluded that the evidence was credible but inconsistent." with the proper references? RSWitwer (talk) 14:06, 16 December 2016 (UTC)

That language rather overstates the case and a mention here is undue here as I said, though maybe okay at resistant starch. We would need a WP:MEDRS secondary source stating the significance of this science in the context of prediabetes. A letter from the FDA that isn't even about prediabetes won't cut it. Alexbrn (talk) 14:09, 16 December 2016 (UTC)

Reducing the risk of type 2 diabetes is ALL about prediabetes. The FDA's decision on the topic certainly qualifies as an independent, third party expert review of the data. I do not understand your suggestion that a less qualified secondary source is required before anything is cited on this page. The beginning sentence of this section is "There is evidence that prediabetes is a curable disease state." This dietary intervention contributes to the evidence of this statement. RSWitwer (talk) 14:23, 16 December 2016 (UTC)

We have distinct articles on diabetes and prediabetes, and sourcing should be specific and relevant for the material in each. The real "meat" of this FDA letter is telling companies petitioning to make exaggerated claims about resistant starch that they can't and that they need to say that the evidence is only "limited" (in other words, weak). Alexbrn (talk) 14:28, 16 December 2016 (UTC)

Why is it sufficient to include information that "A 2015 research project concluded that sildenafil may increase insulin sensitivity in prediabetics" with a only one clinical study while rejecting information that FDA's independent review of 8 clinical studies showing that resistant starch from high amylose corn may increase insulin sensitivity in prediabetics" is unacceptable? You are applying a different standard to this information than to other information on this site. I would suggest the following language "A 2016 FDA review of 8 clinical studies concluded that limited evidence has shown that resistant starch from high amylose corn may increase insulin sensitivity and reduce the risk of type 2 diabetes." RSWitwer (talk) 14:34, 16 December 2016 (UTC)

The 2015 source is not reliable and I have deleted it. You cannot call a letter a "review" as it is misleading, as is hiding the context -- this is a slap down to resistant starch vendors. I have added something to Prevention of diabetes mellitus type 2 where it is more apt than here. Alexbrn (talk) 14:42, 16 December 2016 (UTC)

Thank you for suggesting inclusion of this information on the Prevention of diabetes mellitus type 2 page and for deleting the 2015 sildenafil reference. How could the FDA issue an official letter and approve a qualified health claim without a proper review of the evidence? They use a more thorough review process in their regulatory determinations than any peer-review editor ever could. The eight clinical studies considered by the FDA were not limited to individuals diagnosed with prediabetes, but consistently found statistically significant improvement in individuals with insulin resistance, which is one of the definitions of prediabetes. You are wiggling around the variable definitions between prediabetes and reducing the risk of type 2 diabetes illogically. — Preceding unsigned comment added by RSWitwer (talk • contribs) 15:24, 16 December 2016 (UTC)

They are not "approving" a health claim, they are disapproving a health claim and saying it needs to be qualified by a reference to limited evidence. That is what the source is good for. For wider claims about human health we need good WP:MEDRS to establish weight and ensure accuracy. 15:27, 16 December 2016 (UTC)

The prohibition of a health claim stating a relationship between a food ingredient and a disease is law. As such, there is no such thing as disapproving a non-existing health claim. The FDA just approved the qualified health claim by allowing the communication of the relationship between a food ingredient and a type 2 diabetes as long as the appropriate qualifiers were also communicated. This statement was not allowed prior to the FDA's decision. The WP:MEDRS source talks about needing multiple references in regards to primary sources. The FDA decision is not a primary source - it is a secondary source and has already evaluated the broad evidence in making its decision. It has stated "FDA considers the data and information provided in the petition, in addition to other written data and information available to the agency, to determine whether the data and information could support a relationship between the substance and the disease or health-related condition. The agency then separates individual reports of human studies from other types of data and information. FDA focuses its review (my emphasis) on reports of human intervention and observational studies." This secondary review by an authorized agency of the government does not need additional weight to be communicated. What provision of the Wikipedia criteria am I missing or not understanding please? RSWitwer (talk) 16:12, 16 December 2016 (UTC)

That this kind of source appears nowhere in WP:MEDASSESS. The letter is an okay source on the topic of resistant claims/marketing in the US and that's how we use it. If you want further input I suggest asking at WT:MED. Alexbrn (talk) 16:17, 16 December 2016 (UTC)

Dubious Diagnosis

You might like to know that there has been a critital appraisal of the concept of Prediabetes by the ADA in a recent article in Science: Piller, Charles (2019-03-08). "Dubious diagnosis". Science. 363 (6431): 1026–1031. doi:10.1126/science.363.6431.1026. ISSN 0036-8075. --Aschmidt (talk) 10:43, 16 March 2019 (UTC)

Potential screening topics

I think that the large section on prediabetes screening in a dental setting added as a one off edit here and the recent additions regarding use of continuous glucose monitoring are representative of potential screening techniques that we would generally read about in science magazines. This is probably not the place for them until they become a reality at which time reliable secondary sources will become available and the entire article could probably be moved to Pre-diabetes screening since most of the article would be about that. In the meantime I would like to invite other editors opinions please. CV9933 (talk) 18:16, 14 September 2023 (UTC)

@CV9933, I share your concerns about the current descriptions, but I don't think that a separate screening article is the right choice. What do you think about significantly reducing the descriptions, and putting them in a ==Research directions== section? They both seem to be ideas that are being studied rather than things in current practice. WhatamIdoing (talk) 23:58, 15 September 2023 (UTC)

WhatamIdoing I had considered a thinned down article where remaining content could be merged into Type 2 diabetes#Screening. However even the best merger proposals can fail in the most unexpected ways and there are pros and cons anyway. NICE guidelines (generally reliable sources) encourage people who are at risk of developing type 2 but are less likely to attend a GP surgery to go elsewhere for a risk assessment. They suggest community pharmacies, dental surgeries, NHS walk-in centres and opticians as well as other community venues so not restricted to just dentists, (there are other vulnerable groups). Interestingly they mention 'pre-diabetes' only in inverted commas; maybe it is a term they recognise but avoid, instead describing people as having a moderate or high risk. No mention of CGM, but judging from the summary of methods that they use to develop their guidance, that doesn't come as a surprise because there is no review evidence for them to consider. For that reason I wonder if putting the CGM material into a ==Research== section in the CGM article might be a better compromise. CV9933 (talk) 11:58, 16 September 2023 (UTC)

If it isn't really being used for screening (i.e., today, right now, actual everyday medical practice), then I don't think it should go in "Screening". For example, if NICE recommends going to a dental surgery, and you showed up there, saying "Can you screen me for diabetes?", are they going to say "We're happy to do that" or are they going to suggest going to your GP?

I believe there has been some significant debate about whether pre-diabetes is a thing (in nosological terms), or just a collection of risk factors. WhatamIdoing (talk) 21:27, 16 September 2023 (UTC)

(You're probably right about the CGM thing. I would strongly prefer seeing a much shorter version of it, no matter where it ends up.) WhatamIdoing (talk) 21:27, 16 September 2023 (UTC)

Thanks WAID, the background to this can be found on my talk page where Wickster12345 complained that I had reverted the CGM section that they had added. I gave them the guidelines that we use and I have indicated to them that this is the place to discuss, so would appreciate some input from them before I make any further edits here. Obviously anyone else is free to give their input as well. CV9933 (talk) 10:37, 18 September 2023 (UTC)

Hi, a cursory review of the discussion here makes me agree, the mention of CGM could be (predominantly) moved to the article about continuous glucose monitoring, though I suggest retaining the mention of CGM being explored in this patient population somewhere somewhere in the article about prediabetes as an emerging technology that is being researched; perhaps one or two sentences and I’d invoke Blood glucose monitoring or finger prick tech as well in that context. It should also be explicitly mentioned that it is not recommended by any diabetes association for prediabetics at this time. The reason for this has to do with the sheer volume of research being devoted (as shown in the scientific literature) which means the connection between CGM and prediabetes is not based on a one-off paper here and there for kicks, clicks and funding, but rather on the notion that prediabetics have a different glucose level profile than people not with it. Wickster12345 (talk) 14:35, 18 September 2023 (UTC)

Wickster12345 I am sure that we can edit collaboratively but please take a look at the guidelines that I mentioned previously and also take a look at WP:CRYSTALBALL. I would suggest that you first create a research section as described by WAID above and move your content to work on it in there. With regards to the sheer volume of research that you mention, I think it was Boghog who highlighted a paper a couple of years back whcih described why a lot of clinical research is not really useful and would be a good read if he can recall it. Also please be prepared for anything you contribute to Wikipedia to be mangled beyond all recognition, it is just the way this place works. Regards CV9933 (talk) 18:06, 18 September 2023 (UTC)

There are a couple of dated but I think still relevant publications mentioned here (PMID 16060722, 21892149, 22460880, 16014596). I think this falls under the general topic of Replication crisis. An astonishingly high percentage of biomedical research simply cannot be repeated. Boghog (talk) 18:28, 18 September 2023 (UTC)

Great, I’ll get started on creating a short Research section in the prediabetes article, which will briefly mention CGM. I really don’t want to sound too sticklerish but wouldn’t invoking the above publications to make editing decisions, be considered relying on one’s own primary research, unless there’s a reputable article or review which discusses replication crisis specifically in the context of publications regarding CGM use by prediabetics? Wickster12345 (talk) 19:57, 18 September 2023 (UTC)

I’m referring to the articles Boghog found Wickster12345 (talk) 19:58, 18 September 2023 (UTC)

The replication crisis in biomedical research is well documented and continuous glucose monitoring (CGM) is clearly within the scope of biomedical research. At the same time, it is not reasonable expect that review articles have been written about the replication crisis within every subdiscipline of biomedical research. Conclusions from primary sources about biomedical research are at best preliminary because they have a significant chance of being wrong. These conclusions need to independently reviewed and put in the context of related studies before they can be considered reliable. Fortunately a large number of review articles have been published on the subject of CGS. So there is no reason to rely on primary sources. Boghog (talk) 04:59, 19 September 2023 (UTC)

I think the main thing is to keep the research section short and relatively broad. It could literally be as short as "Research is being done on A, B, C, and D", with links to each.

BTW, in terms of encyclopedic style, you might be interested in reading s:1911 Encyclopædia Britannica/Diabetes. At the time, this was considered surprisingly lively writing for an encyclopedia. WhatamIdoing (talk) 05:21, 20 September 2023 (UTC)

I have omitted the dental section and moved CGM to ==Research directions== with a rewrite and review cite, CV9933 (talk) 13:03, 5 October 2023 (UTC)

Thanks. That looks better. WhatamIdoing (talk) 20:26, 6 October 2023 (UTC)