There's Nothing "Pre" About Prediabetes
Slowing the progression from prediabetes to diabetes.
By Wil Dubois
If you had the misfortune to be exposed to plutonium-239, you'd remain radioactive for about 24,100 years. As you'd be highly unlikely to live that long, it's safe to say you'd light up the night for your entire life. Something simliar happens in the diabetes realm on the cellular level. Red blood cells that get exposed to glucose never shake off the effects of that exposure — called glycosylation. They are changed for the rest of their lives.
This queer fact of microbiology lets us run a lab test from a single drop of blood that measures the intensity of this sugar-radiation exposure. Like ants, butterflies, and woodland voles, red blood cells live for about three months, so the test, called an A1C, gives us a three-month window into the blood sugar environment those cells lived in. "Normal" people score 5.6 and below on an A1C test. A score of 6.5 or higher earns you a diagnosis of diabetes.
But what about the scores in between? The scores that are higher than "normal" but lower than slum-dunk diabetes? The lab values between 5.6 and 6.5? Doctors diagnose this no-man's land as either abnormal blood glucose or impaired blood glucose tolerance — but in the vernacular everyone simply calls it prediabetes. And that's a terrible mistake.
First, the term prediabetes sounds deceivingly harmless. It sounds like not-yet-diabetes, which to many people translates to not-diabetes. And second, the term makes it sound like a wholly separate condition from diabetes. But prediabetes and diabetes are just different degrees of the same disease. It's the difference between a cute little tiger cub and a full-grown ferocious man-eater. Same critter in a different phase of life, that's all. And the prediabetes label doesn't do a good job of conveying that message. So much so, in fact, that diabetes advocate and Huffington Post Columnist Riva Greenberg is calling on the medical community to change the name of prediabetes to "stage 1 diabetes."
Using this cancer linguistics might not be a bad idea, because there's really nothing "pre" about prediabetes. It's literally the first stage of diabetes, a progressive disease that gets worse over time. Left alone, diabetes grows. It gets bigger. Meaner. Just like that tiger cub we were talking about. If someone tells you that you have prediabetes, what you really have is diabetes. The train has left the station. You can't stop it. (Yes I know I'm mixing my metaphors, but let's just pretend it's an old-fashioned circus train with boxcars full of tigers.)
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I recently read a very interesting article on the state of precision medicine in the treatment of cancer in Popular Science magazine. Precision medicine, also called "individualized medicine", uses several types of genetic markers for known medical...