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Message: <blockquote data-quote="phoenix" data-source="post: 106122" data-attributes="member: 12578">Not necessarily,   and certainly its's not the case for people with impaired glucose tolerance. One study showed of  people with IGT at baseline,  and  another The definition of what is diabetes, and what is IGT/IGF  (Its the US that uses the term pre diabetes)is fraught with difficulties,  It''s  a definition of best fit , they have to use available evidence, which is often contrary  and the committee then has to take into account the economic  burdens of health care  worldwide!The World health organisation did a review a couple of years ago, they looked at the evidence for the levels used to diagnose diabetes, Igf and Igt. They used data from retinopathy/glucose levels, there was hardly  any valid data  available on other complications, and from population studies to define the diabetic cut off line. This was the level that ' there is a significantly increased premature mortality and increased risk of microvascular and cardiovascular complications.' They decided that in spite of poor quality  evidence they could keep the present cut off point.(fasting plasma glucose ≥ 7.0mmol/l (126mg/dl) or 2–h plasma glucose ≥ 11.1mmol/l (200mg/dl))Having decided that the present level was OK.  They looked for a lower  level to define normal blood glucose levels, the level at which there was no risk. The data couldn't supply a lower level, many relationships were linear to a low point. They ended up saying '‘normoglycaemia’ should be used for glucose levels associated with low risk of developing diabetes or cardiovascular disease, that is levels below those used to define intermediate hyperglycaemia' Then they looked again at the IGT and IGF. First,  as they weren't able to define a level that was normal, they couldn't define a level where things became 'abnormal' . Not everyone with an impaired  glucose tolerance test  goes on to develop diabetes or the complications of diabetes.(only 30%  in the study mentioned above)  There is also  some evidence that lifestyle interventions  can prevent/delay  problems. On the other hand  studies showed that  the the risk of future diabetes, premature mortality and cardiovascular disease begins to increase at 2–h plasma glucose levels below the  present IGT range.WIth the  the impaired fasting glucose limit  there was an additional factor to consider because the US had lowered the cut off point from 6.1 to 5.6mmol . Theres too much to go into here but again the evidence isn't clear cut.At the end the committee decided to keep the levels the same for the moment but they clearly feel that fairly arbitrary cut off figures are not  the best method of defining/diagnosiing  a person at risk of diabetes and it's complications  they sayand they put this in their recommendations for both impaired fasting glucose and impaired glucose tolerance.In other words, the glucose levels are only one part of the package, no particular level is necessarily'pre diabetic', nor is any particular level 'safe'.</blockquote>

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