Does Online Testing Overdiagnose Prediabetes?

A short online test promoted by the CDC, American Medical Association, and American Diabetes Association evaluates respondents’ health status to determine their risk of having prediabetes. However, some doctors worry that too many people will fall into the high-risk category, contributing to the overuse of resources that can occur when common conditions are medicalized.

The “Do I Have Prediabetes?” test asks several questions about risk factors like gender, age, family history, physical activity, and weight category, then tallies the responses for a score out of 10. A person scoring 5 or higher is deemed “likely to have prediabetes” and therefore at high risk for type 2 diabetes (T2D). Respondents in this category are encouraged to ask their doctor about additional testing.

However, some doctors feel that the at-risk determination is based on broad criteria that lump too many people into the prediabetes category. The results of a survey were published in a research letter by Saeid Shahraz, MD, PhD, of Tufts Medical Center in Boston and colleagues in JAMA Internal Medicine. The authors found that the assessment benchmarks would categorize 60% of Americans over the age of 40 as prediabetic; for Americans over 60, that number jumped to 80%. The researchers fear that many otherwise healthy people will go to their doctor and ask for glucose testing as suggested by the prediabetes assessment, putting a strain on resources.

Many clinicians also disagree with the increasingly common perception of prediabetes as an actual medical condition. Labeling a disease predecessor as a medical disorder contributes to the progression toward medicalization, turning otherwise healthy people into patients. This influx of additional patients could actually reduce access to care for T2D patients who more urgently need it.

The research letter authors stated that “a valid method to examine for prediabetes should avoid unnecessary medicalization.” Instead, they say, “screenings should seek to concentrate on people at highest risk to allow for efficient distribution of limited health care resources.”

Part of the narrative around prediabetes, a term unheard of 10 years ago, is that it can be reversed, serving as a “wake-up call” for people who are possibly on a path to diabetes. The recommended interventions include lifestyle changes like increasing physical activity, choosing a healthier diet, managing one’s weight, and quitting smoking. However, some researchers argue, these positive choices should be promoted regardless of a person’s prediabetes status, since they can help fight the obesity epidemic and improve health in general.