Over Diagnosis?

[Landshark]

On another topic ...

How many non-diabetics self-test? I bet it is not many. The reason for much of the hype over the rising numbers of diabetics is partly due to real rising figures, but more to do with the acceptance of guidelines over common sense. For example; if you self test every month and are below say 8 mmol in your readings. For many years, this would have been non-diabetic. Of the number was reduced to 7 mmol, then those between 7 and 8 would now be captured and the revenues for the drug companies increases. Now take it one stage further and say that the upper limit is now to be 6 mmol, well, there you have it - a load more people get caught in the new drug regime.

The acceptance of new guidelines is necessary for the doctors and nurses as they need to have something in place under which they can safely prescribe and diagnose. However, blood chemistry is a weird science (ask any haematologist) and what you ate the night before can have a long term affect on your body's ability to resolve your over/under indulgences.

I believe that diabetes is over-diagnosed by GPs. In order to tell whether Type 2 really exists there needs to be far more work done, but this would meet with a lot of resistance from the cartels. Yes, there is pre-diabetes (it is called rude health) and yes there is Type 2 (it is called over indulgence and/or poor diet); but proving conclusively that these are actual medical conditions and not statistical aberrations can only come from popular proof by numbers. Are you up for it?

 

[phoenix]

I believe that diabetes is over-diagnosed by GPs. In order to tell whether Type 2 really exists there needs to be far more work done, but this would meet with a lot of resistance from the cartels. Yes, there is pre-diabetes (it is called rude health) and yes there is Type 2 (it is called over indulgence and/or poor diet); but proving conclusively that these are actual medical conditions and not statistical aberrations can only come from popular proof by numbers.

The criteria for diagnosis are the product of a World Health Organisation committee. I don't feel that there is any benefit for either the organisation or the individual members in falsely raising the criteria.
The members were representatives come from all continents and countries with widely different accessibility to health care.
In the most recent review , they left unchanged the criteria set in 1999. They re-examined the evidence and if fact decided not to lower the levels for the diagnosis of impaired fasting/glucose tolerance not supporting the USA who have 'unilaterally' lowered the criteria for 'pre diabetes' from 6.1mmol/l to 5.6 mmol/l
The evidence they used is available for anyone to read.
http://whqlibdoc.who.int/publications/2 ... 34_eng.pdf
and update sanctioning the use of HbA1c for diagnosis
http://www.who.int/diabetes/publication ... c_2011.pdf

 

[noblehead]

Yes, there is pre-diabetes (it is called rude health) and yes there is Type 2 (it is called over indulgence and/or poor diet); but proving conclusively that these are actual medical conditions and not statistical aberrations can only come from popular proof by numbers. Are you up for it?

:shock: .... :think:..... :silent:

 

[Hydrazine]

Hi Landshark,

Not entirely sure what you're getting at here.

As far as I know, fasting blood sugar above 7.8mmol is abnormal. If you are 'pre-diabetic' and you make certain lifestyle change,s you may be able to prevent full type 2 diabetes and thus avoid medication (so this diagnosis could help prevent an additional revenue stream to the drugs companies and save NHS funds).

As for type 2 diabetes 'not existing' it most certainly does. How can someone with a fully functioning pancreas have blood sugar in the teens and twenties? Agreed, lifestyle factors do have a part to play in it but so does genetic factors. The amount of data we have regarding diabetes in the general population now is huge, and the costs associated with treating the complications are equally large. So to me it makes sense to diagnose someone with borderline or pre-diabetes as such and hopefully give them a chance (and a kick up the bum) to avoid full blown diabetes. And if someoune already has diabetes then it makes sense to treat them for it to avoid complications.

I think diabetes is becoming more prevalent due to the western lifestyle and increased life expectancies. I'm not sure it's a 'statistical aberration'.

 

[Grazer]

Oh dear :roll:

 

[borofergie]

I believe that diabetes is over-diagnosed by GPs. In order to tell whether Type 2 really exists there needs to be far more work done, but this would meet with a lot of resistance from the cartels. Yes, there is pre-diabetes (it is called rude health) and yes there is Type 2 (it is called over indulgence and/or poor diet); but proving conclusively that these are actual medical conditions and not statistical aberrations can only come from popular proof by numbers. Are you up for it?

Yes you could arbitrarily change the criteria and instantly reduce the number of diagnosed T2 Diabetics. What would be the point of that? How many other "statistical aberrations" can you think of that are confused with "epidemics"?

According to your profile you aren't a diabetic Landshark, what are you hoping to achieve by coming to a forum populated by T2 diabetics and labeling their disease "over indulgence and/or poor diet". If your aim is not to provoke, and you seriously think that that all T2 diabetics are "fat and lazy" then your understanding of the condition is very poor indeed.

 

[Paul1976]

Landshark.I'm not disrespecting you in any way but I would ask if your post is solely aimed at causing a negative reaction-If I'm wrong then my sincere apologies.

 

[Grazer]

I believe that diabetes is over-diagnosed by GPs. In order to tell whether Type 2 really exists there needs to be far more work done, but this would meet with a lot of resistance from the cartels. Yes, there is pre-diabetes (it is called rude health) and yes there is Type 2 (it is called over indulgence and/or poor diet); but proving conclusively that these are actual medical conditions and not statistical aberrations can only come from popular proof by numbers. Are you up for it?

Yes you could arbitrarily change the criteria and instantly reduce the number of diagnosed T2 Diabetics. What would be the point of that? How many other "statistical aberrations" can you think of that are confused with "epidemics"?

According to your profile you aren't a diabetic Landshark, what are you hoping to achieve by coming to a forum populated by T2 diabetics and labeling their disease "over indulgence and/or poor diet". If your aim is not to provoke, and you seriously think that that all T2 diabetics are "fat and lazy" then your understanding of the condition is very poor indeed.

+1, or more if I can! Gruff gruff.

 

[Landshark]

@phoenix - I'm afraid I am far more sceptical having been on committees in the past. The issue is not what is worldwide, but what passes for general health care in the UK. When you are told that the criteria for diagnosing diabetes in a patient is if the fasting bg is above 6.1 mmol, and the WHO has another number or a consultant uses 5.9 mmol it has to be asked why this is the case?

My argument here is not so much the numbers as what what needs to be regarded as "Normal" before alarm bells are rung. Yes, the fasting mmol needs to have a limit, but it should not be an arbitrary rule that demands immediate attention. A doctor declaring a patient a diabetic based on a number that happens to be his "suited" number of choice has massive implications on the individual. If the WHO recommends 7.x as a fasting mmol, then why do we use 6?

The definitions of "pre-diabetes" and "Type 2" has been (and continues to be) a very volatile argument that seems to involve a few activists.

As far as the HbA1c data is concerned, you need to be careful here as even the WHO regarded this data as "moderate" with its conclusions being "conditional" which is hardly a glowing endorsement.

@Paul1976 - I am trying to make people think who may not be Type 2 but may be obese and need to change diet or rethink a sedentary lifestyle.

@borofergie - I was diagnosed as Type 2 in January this year, but since then have been part of a study as to why my HbA1c data said I was diabetic yet my fasting glucose has never exceeded 5.9 mmol since.

@ everyone else who may disagree - yes that is why I posted this. My concern is that there are many people who are genuine diabetics who are not receiving proper care or proper diagnosis in the first place. I am not trying to inflame a situation for those with chronic conditions, just asking a simple question - how convincing are your numbers? Had anyone told me that pre diabetes or Type 2 could be easily misdiagnosed, I would have been more happy than being told that I was to be put on medications immediately and prescribed a lifetime of treatment. As it happens, they made a mistake in my case. Now diet and constant monitoring is part of my lifestyle.

Finally - anyone stating that I am saying that all T2s are "fat and lazy" are simply wrong. I have never stated or inferred that.

 

[phoenix]

@phoenix - I'm afraid I am far more sceptical having been on committees in the past. The issue is not what is worldwide, but what passes for general health care in the UK. When you are told that the criteria for diagnosing diabetes in a patient is if the fasting bg is above 6.1 mmol, and the WHO has another number or a consultant uses 5.9 mmol it has to be asked why this is the case?

conspiracy theory at work?
Just to get facts straight. The criteria (using fasting glucose ) for diagnosis of diabetes anywhere in the world is 2 fasting glucose levels over 7mmol/l. It is actually quite important that criteria are similar since many of us move from place to place. I don't live in the UK and I'm glad to say the health care system I use, uses exactly the same criteria.
Your earliest recorded levels on here were well over 7mmol/l
edit to add the suggested HbA1c criteria:British Clinical Diabetologists, just in case anyone reading this thread thinks it's 6.1%

HbA1c ≥48 mmol/mol can be used to diagnose diabetes in most situations. In
patients without diabetes symptoms repeat venous HbA1c in the same lab within 2
weeks. If the second sample is <48 mmol/mol (6.5%) treat as high risk of diabetes
and repeat the test in 6 months or sooner if diabetes symptoms develop. In
symptomatic adults with relatively slow onset of symptoms a single result ≥48
mmol/mol will suffice

 

[Paul1976]

The only difference being the units that BG is measured in,7mmol/l or 120mg/dl.

 

[borofergie]

@borofergie - I was diagnosed as Type 2 in January this year, but since then have been part of a study as to why my HbA1c data said I was diabetic yet my fasting glucose has never exceeded 5.9 mmol since.

You seem to be extrapolating your own experiences and applying them to everyone else Landshark. Most of us are diagnosed with huge HbA1cs (10.2% in my case) and big fasting BG scores that we struggle constantly to manage.

I am sure, as with every condition, some people are honestly misdiagnosed, but I somehow doubt that there are legions of T2 Diabetics who just crept inside the existing criteria.

Finally - anyone stating that I am saying that all T2s are "fat and lazy" are simply wrong. I have never stated or inferred that.

Yes you did. You said this:

there is Type 2 (it is called over indulgence and/or poor diet)

 

[Grazer]

- I was diagnosed as Type 2 in January this year, but since then have been part of a study as to why my HbA1c data said I was diabetic yet my fasting glucose has never exceeded 5.9 mmol since.

Who's study? There are lots of us on here who's fasting BG is never over 5.9. It's called modifying your diet. Or are we all mis-diagnosed?

 

[Defren]

Or are we all mis-diagnosed?

I think we would all love that, but surely our Doctors can't be wrong - all of them! Since landshark seems an absolute authority on this, I shall go and have a fish and chips for dinner, followed by a curry with a huge mound of rice for supper, with a load of bread as snacks in between, seeing as we all over indulge and are all misdiagnosed!

 

[Grazer]

Or are we all mis-diagnosed?

I think we would all love that, but surely our Doctors can't be wrong - all of them! Since landshark seems an absolute authority on this, I shall go and have a fish and chips for dinner, followed by a curry with a huge mound of rice for supper, with a load of bread as snacks in between, seeing as we all over indulge and are all misdiagnosed!

Can I join you with my packet of chocolate hob nobs and peppermint Aero?

 

[Paul1976]

Or are we all mis-diagnosed?

I think we would all love that, but surely our Doctors can't be wrong - all of them! Since landshark seems an absolute authority on this, I shall go and have a fish and chips for dinner, followed by a curry with a huge mound of rice for supper, with a load of bread as snacks in between, seeing as we all over indulge and are all misdiagnosed!

:lol: :lol: :lol: :lol: I'll bring the Doorstep white bread jam sandwiches and the Kendal mint cake!! We're all cured i tell you!! :lol:

 

[Patch]

I believe that diabetes is over-diagnosed by GPs. In order to tell whether Type 2 really exists there needs to be far more work done, but this would meet with a lot of resistance from the cartels. Yes, there is pre-diabetes (it is called rude health) and yes there is Type 2 (it is called over indulgence and/or poor diet); but proving conclusively that these are actual medical conditions and not statistical aberrations can only come from popular proof by numbers. Are you up for it?

I agree with some of this statement (definitely NOT the bit about T2 being down to over indulgence!).

It is entirely possible that SOME people are just designed to run on a higher BG level. What I think LS is getting at, is that this is NOT being considered by the medical profession.

Maybe it should be?

 

[Unbeliever]

Good point Patch. I shouldn't be surprised if this is proven one day . It happens with other things - cholesterol for.
example..

 

[hanadr]

Landshark
I objct to the following statement you made; yes there is Type 2 (it is called over indulgence and/or poor diet);
Hana

 

[Defren]

I think we would all love that, but surely our Doctors can't be wrong - all of them! Since landshark seems an absolute authority on this, I shall go and have a fish and chips for dinner, followed by a curry with a huge mound of rice for supper, with a load of bread as snacks in between, seeing as we all over indulge and are all misdiagnosed!

Can I join you with my packet of chocolate hob nobs and peppermint Aero?

Only if you share :lol: