Dr Peter Brukner OAM

The time is now: New diagnostic threshold for type 2 diabetes proposed

2 mins read

A new paper suggests current thresholds for diagnosing type 2 diabetes are outdated and do not represent current advancements in understanding the disease. A group of authors, including two Emeritus Professors from prestigious American universities, have suggested that it’s time for new lower diabetes diagnostic thresholds.

The latest evidence supports early intervention to delay or reduce adverse outcomes in patients with type 2 diabetes

What did the study entail?

The authors believe that an artificial distinction exists between pre-diabetes and type two diabetes and propose a new definition that includes all glucose intolerances above 5.7%. Currently, patients with a blood sugar reading of between 5.7% and 6.4% are diagnosed as having pre-diabetes (this is the range defined by the American Diabetes Society, however Diabetes UK and the Australian Diabetes Society define pre-diabetes as having an HbA1c between 6.0%-6.4%). 

The time is now: New diagnostic threshold for type 2 diabetes proposed

The group stated that pre-diabetes association with vascular complications is almost as important as the number who will progress to full-blown type 2 diabetes.

Interventions aimed at patients living with pre-diabetes have the potential to decrease the risk of progression to type 2 diabetes as well as vascular complications. The researchers believe all patients in this category should be treated with diet and lifestyle modifications.

Why is this study important?

The researchers concluded that re-evaluating and shifting the type 2 diabetes thresholds would be a significant step towards improving patient’s long-term health as the complications of type 2 diabetes often begin during pre-diabetes. Earlier therapeutic interventions could potentially prevent the progression of complications or even cause their resolution.

In the case of Australia, that would increase the number of people with type 2 diabetes from the current 1.7M (1.2M diagnosed and 0.5M silent, undiagnosed) to include the 2.5M living with pre-diabetes, resulting in more than 4M with the diagnosis. It would potentially make it more likely that those previously categorised as “pre-diabetic” would be prepared to make the necessary lifestyle changes.

Food for thought.

Schwartz SS, Rachful AW, Corkey BE. The time is now for new, lower diabetes diagnostic thresholds. Trends in Endocrinology & Metabolism 2021 https://doi.org/10.1016/j.tem.2021.10.007

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