Replies to post #119574 on Biotech Values

[iwfal]

Not sure, but believe a decade ago pre-diabetes was defined by a fasting glucose greater than 110. Agree that hemoglobin A1c did not enter into the definition.

You are correct that the old IFG definition was FBG>110. My mis-memory.

Believe the earlier pre-DM designation was that people between 110-126 had greater than 50% more likelihood of developing DM than a population below 110.

DM researchers/educators/supporters/fanatics have often been overly aggressive in scaring people about the disease (although it is a major health challenge).

Agree this is an issue - some weird kind of attempt to define everyone as pre-diabetic. But nonetheless the rate of progression to diabetes is still very sizeable over a decade.

IFG pre-diabetes: See the cite at the bottom of the page which notes that if a patient's initial IFG is less than 110 their rate of progression to diabetes is substantially lower over, say, 5 years, than someone whose initial IFG measures more than 110. But nonetheless the total rate of conversion over about 3 or 4 years, even for the new added category of pre-diabetes (100<FBG<110), is about 8% convert to diabetes. Guesstimate that over a decade it would be 15-25%. For the lower proportion of the population that has a first IFG of FBG>110 the conversion rate in a decade is probably close to 50%. For those with IFG prediabetes.

IGT prediabetes: For the smaller percentage with isolated IGT prediabetes (which HbA1c should pick up) I'd expect a higher conversion rate since IGT is more 'progressive'. Say 50%.

All told I'd guesstimate that 40% of pre-diabetics as measured by FBG>100 or HbA1c>6.0 would be diabetics within a decade. Less significant than my initial reaction - especially since a significant fraction will die before getting to diabetes (pre-diabetics tend to be older). And of course many of the existing diabetics will die in a decade. All told it roughly aligns with the prevalence predictions of a doubling in about 20-30 years.

Paper on IFG initial FBG value vs progression risk:
http://care.diabetesjournals.org/content/30/2/228.full.pdf+html