Dangerous Overdiagnosis of Diabetes

There's a dangerous epidemic out there. It's called overdiagnosis-when you are diagnosed with a condition that will never hurt your health.

Overdiagnosis can lead to potentially harmful medical care, as you undergo invasive tests, take medications or have surgery-all for a condition that is harmless. Medical care also can be expensive, time-consuming and anxiety-producing. type 2 diabetes is a condition that is frequently overdiagnosed...

More than 29 million Americans have type 2 diabetes, which can cause complications such as heart disease, kidney failure, blindness, nerve pain and leg infections that lead to amputation.

However: Like high blood pressure, type 2 diabetes has a range of abnormality, from the asymptomatic to the severe. Some people with diabetes will never develop complications.

That's even more likely nowadays because the medical definition of type 2 diabetes and therefore, the criteria for who should and should not be treated-has changed. The definition of type 2 diabetes used to be a fasting blood sugar level higher than 140 mg/dL. Today, it is a fasting blood sugar level higher than 126 mg/dL-turning millions of people into diabetics. A newer test-hemoglobin AlC, a measurement of long-term blood sugar levels that detects the percentage of red blood cells coated with glucose (blood sugar)-defines diabetes as a level of 65% or higher.

My viewpoint: Physicians should use medication to reduce blood sugar in patients with an AlC of 9% or higher... discuss treatment with patients between 8% and 9%... and typically not treat patients under 8%.

In a randomized trial designed to test the effect of aggressive blood sugar reduction, more than 10,000 people with type 2 diabetes and AlC levels above 8% were divided into two groups. One group received intensive glucose lowering therapy aimed at reducing AlC to less than 6%. The other group received standard therapy, targeting a level of 7% to 7.9%. After three years, the intensive-therapy group had about 25% increased risk for death, and because of that, the trial was stopped.