How blood sugar myths are harming you: What you need to know about diagnosis truths

 Written by Dr. Ambrish Mithal

Source: https://indianexpress.com/article/health-wellness

Over the past few months, social media has been flooded by new information about the diagnosis of diabetes that runs contrary to science. Many people believe in these fake unscientific forwards on their phone and end up damaging their health.

What’s floating online?

Most of these so-called experts claim the following:

1. The criteria for diagnosis of diabetes has been altered frequently in recent years.

2. These alterations have reduced the threshold level of blood sugar used to diagnose diabetes.

3. Reduction in diagnostic levels leads to millions of additional people being labelled as diabetics.

4. These changes are decided upon by a few ‘wise’ men seated on a table according to their whims, based on random parameters.

5. More people being diagnosed with diabetes means more will require medication.

6. All experts who are involved in this decision making are hand-in-glove with drug manufacturers. So ultimately the process is driven by the pharmaceutical industry so that they can make billions of dollars.

Are these allegations true?

In 1979, the WHO formally defined diagnostic criteria for diabetes mellitus based primarily on plasma glucose levels — fasting plasma glucose more than or equal to 140 mg/dl, and a two-hour post-glucose value more than 200 mg/dl.

In 1997, the threshold for fasting plasma glucose was lowered to 126 mg/dl by the American Diabetes Association (ADA). The post-glucose cut-off of 200 mg/dl was retained. The 1997 changes in the diagnostic criteria for diabetes were influenced by studies which provided evidence that levels between 126 and 140 mg/dl were also associated with an increased risk of diabetes-related complications, supporting the need for lower diagnostic thresholds for diabetes.

The diagnostic criteria for diabetes have not changed since 1997.

What about prediabetes?

The 1979 WHO criteria recognised impaired glucose tolerance as a post-glucose value between 140 and 199 mg/dl. This is the same as we use today. The major change in 1997 was the inclusion of a category called impaired fasting glucose — fasting glucose values between 110 and 125 mg/dl. In 2003, the ADA further lowered the fasting glucose criterion to 100 mg/dl. Some studies showed that individuals with fasting glucose levels between 100 and 109 mg/dL were also at a higher risk of progressing to Type 2 diabetes. Additional research indicated that fasting glucose levels in the range of 100 to 109 mg/dL were associated with an increased risk of cardiovascular diseases. However, the WHO continued to use a fasting level of 110 mg/dl as a cut-off.

 Glucose Testing and Interpretation

Since then the cut-offs for fasting plasma glucose and oral glucose tolerance tests have remained the same with the only change being HbA1c (average blood sugar counts of three months) included in 2009. An HbA1c level of 6.5 per cent or more is diagnostic of diabetes mellitus. Levels between 5.7 to 6.4 per cent indicate prediabetes.

The importance of prediabetes lies in the risk of its conversion to diabetes or possible remission. In India 60 per cent of those with prediabetes convert to diabetes in five years. Initiatives like the Indian Diabetes Prevention Programme (IDPP) have demonstrated that lifestyle interventions can reduce the risk of progression to diabetes by about 28-35 per cent. Medications are used for a minuscule number of people with prediabetes. The last change in diagnostic criteria in 2003 added a large number of people to the pool of prediabetes so that people could recognise their risk and initiate lifestyle changes.

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The increase in diabetes prevalence is real and not because of changed criteria. Consult a qualified practitioner.