NYT: How Meaningful Is Prediabetes for Older Adults?
 

"A new study indicates that the condition might be less of a worry than once believed."

https://www.nytimes.com/2021/02/23/...tes-selvin.html

Interesting piece. I'll be interested in seeing what others think about it.

My thoughts are Susan Weinberg was already taking 2 drugs for HBP, a statin, and another drug for Osteoporosis. She had the classic symptoms of Metabolic Syndrome. The HbA1C reading should not have been a surprise. People with these symptoms travel down a path leading to T2D eventually unless they change lifestyle, which starts with foods consumed.

This article is not controversial, but the situation could be represented more accurately, particularly when A1C levels have been gradually lowered to represent pre- or full T2D over the years. Similar to how high blood pressure confirmation has been lowered from 140/90 to above 120/80. The long shadow cast by pharmaceutical giants lurking in the background is quite clear.

When people start exhibiting symptoms of Metabolic Syndrome (MetS), and I was one quite a few years ago, there are actions that can be taken to completely eliminate those symptoms; yet, there are two problems that cloud the issue today. The first is that these symptoms are treated as separate diseases rather than symptoms of MetS that can be controlled and eliminated through targeted lifestyle changes favoring foods consumed first. Doctors freely prescribe drugs encouraged by highly profitable Pharma that never treat the root cause and often cause damaging side effects.

The second is that the ADA message is still quite unhelpful and by its lack of a strong message communicating actions which can be taken to control this condition. This dynamic leads to a very confusing cascade of contradictory information based on false beliefs supported by the medical, nutritional, and pharmaceutical communities. How one navigates through this jungle without doing their own research to go against the grain is baffling and alarming.

Regarding the first point, hubby recently got his first A1C and it was 6.4, very top of the range for pre-diabetes, with an average level of 137. His doc loves prescribing meds and I told hubby that he needs to get back on the LC wagon pronto to avoid meds. After the test he got a note from his doc saying his level was "fine" and that he can lower the number through lifestyle changes. Hallelujah!

Your second point about doing your own research is spot on, except that some people wouldn't know where to start other than by talking to their doctors or listening to TV commercials. A lot of older adults are not computer-savvy and are unable to delve into these issues. It's sad, really, that the ranges keep getting lowered so that they can get more people on meds. I think the normal reading for cholesterol used to be something like 250.

Bawdy - Glad to hear your husband's doctor supports lifestyle modifications. That's huge. It's empowering to know that your physician supports the fact that you can fix yourself with some changes and what appear to be sacrifices at first; yet, later become very satisfactory and healthy adaptations.

Yes, it is alarming that many don't know where to start, especially if/ when they realize that the authorities they've relied on for so long can be so wrong. The ADA could be a beacon on this topic, but is completely unhelpful. The doctors that treat us rely on the ADA for lifestyle guidelines and Pharma for the drugs to prescribe. Wow.

Same with blood pressure. People even get put on BP meds for having "White Coat Syndrome". My sister & I had to be very persistent to get my mother taken off them. In assisted living she often felt light-headed on BP meds + low-salt diet, but after she fell & hit her head, we brought her home to live with my sister. With weekly visits from nurses who took her BP in the comfort of home, they found both numbers to be dangerously and consistently low. Two even went out to their cars to get their child-size cuffs to make sure the fit wasn't the problem. Her BP was also measured before, during & after PT & OT sessions. It did rise a bit with exercise, but still was way below normal, all because of the meds. The doc only let us take her off the meds because she was being monitored weekly by RNs with additional measurements by PTs & OTs.

I find this statement absurd. Yes, if the person reached a certain age before the numbers crept up, okay: but it's not good.



It is amazing how many chronic conditions are Metabolic Syndrome; when it's all the same condition.

I would generally agree with most points in the article.

One point that was made, almost in passing, is the notion of deceiving the patient into do the "right thing". I find that notion offensive. The doctor should INFORM the patient of everything, including the pros, cons, and likelihoods, and options (including the option to do nothing). Then let the patient decide what course of action they want to pursue.

Somewhat tied in with this is how the current medical establishment "educates" people into eating the very things that will make their condition worse. At least this is slowly beginning to change.

Totally agree, yet there are still doctors out there who will drop you as a patient if you don't agree to take all the medications prescribed. Of course, that's a perfect reason to drop the doctor!

:agree:

What's described in the study is an initial visit to the clinic, then a later follow up. So are we working from just two measurements of HBA1C? What percentage of people with a right on the high end of normal HBA1C at a single visit just went through a month where there were more office birthday parties than usual, or something? An occasional 5.8 in a non-diabetic with no real risk of diabetes isn't that unusual. Two screenings five years apart weren't that predictive--getting screened at every doctor visit doesn't need to be predictive, it simply measures what's going on.

That's very true. My husband's doc wanted him to do an A1C on January 2. I said NO WAY, not with just getting past Thanksgiving and Christmas! Unfortunately, postponing it until early March still got him a 6.4. We're working on it, though.

Concur. As with many things that get published, the data on which the "findings" are based often don't rise much above anecdotal speculation.

If you have a borderline A1c, the response should usually be, "Okay, this is a bit higher than normal, but that may or may not mean anything. Let's check it again in six months to a year and, if it's still up, we'll monitor it even more closely and discuss what, if any, actions we'd like to take."