OT....goodbye prediabetes?

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Really? That “prediabetes” is harmless enough that there’s no need to worry until true T2D is reached? No wonder @McLovin1981 sister is so cavalier about her own prediabetes, then if the CDC says it’s ok.

Srsly, though….you keep banging on about risk factors (and to be fair, a good many articles do use that term a lot…..assuming, I imagine, that the reader will infer that elevated risk translates to something worthwhile responding to) Note, however, that in doing the Google AI overview thing, I did not use “increased risk” in the prompt but rather specified “causal relationship” ….. the better to be informed if what I think I know just ain’t so. Available evidence strongly suggest that it is so. That to me puts a different complexion on the “only” prediabetes misunderstanding. Just as in, say, mildly elevated LDL-C is a risk factor ASCVD. ….doesn’t mean that there’s necessarily any underlying pathophysiology roiling away. However, there is an undeniable causal relationship between the two, depending upon the nature of the lipid particles making up that mildly elevated number….and if that risk factor is ignored for long enough the the end result can most definitely be called a disease! Plenty of denialism in this field also.

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You are assuming the doctor and patient worrying changes things. People do their worst work worrying.

You are also assuming if the cdc only knew better patients could worry, which is ridiculous.

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Au contraire, I seriously doubt that the CDC does actually contend that prediabetes…..or, more specifically an HbA1c of 6% ….. is innocuous, or that there’s no causal relationship between the metabolic dysfunction that figure is a result of and the diseases cited upstream.

I can see why such a confident assertion is so popular mind. Much easier/ reassuring to rant about The Healthcare Industry creating another disease to treat and bill for rather than accept that waiting for the advanced disease to take hold is outdated thinking dating back to the 1970s when prediabetes was first proposed as a concept, apparently ….when, presumably, there were fewer non invasive diagnostic tools to demonstrate the existence of those associated chronic diseases or determine the pathophysiology.

There’s little benefit to being reassured of rude good health when just the opposite is the case…..as a few of us on this board can certainly attest to

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And now we have the human pretzel.

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I thought I was OK by stopping my old Pepsi addiction, bought a case of Diet Coke or Pepsi, one was enough to make me sick, I emptied, all the rest of the case, recycled the cans, never did that again, the aspartame did me in, flipped to Kirkland Italian Sparkling water, it’s been years ago now, not going back! Found it better to just stop all the sugar water drinks, cold turkey, I suppose…

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I buy 4 cases of the Kirkland Italian Sparkling water every time.

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WORD!

For assistance with dietary choices, very little beats cutting out artificially sweetened beverages (if they form a big part of someone’s daily intake) avoiding them completely. FWIW, I classify table sugar/sucrose/any iteration of glucose and fructose as an artificial sweetener when added to something that isn’t naturally sweet.

Tastebud rehab is what I subsequently called it with my patients when discussing how to avoid all the “pre-root canal” years of dental treatment as well as maturity onset diabetes (as we called it back then)……and it has the effect of sensitizing a personto all the hidden sugars in what’s now been baptized Ultra Processed Food. Fortunately for my retirement portfolio, folk ignored my suggestions as much as folk with “prediabetes” do their physicians.

I grew up in a household where two spoons of sugar was as de rigeur in a cup of tea as the tea leaves and water…..a response to years of rationing post WWII, I expect. One morning in my early teens, I picked up my morning cuppa before my mum had sugared it and found I preferred the taste. That lack of an acquired “sweet tooth” (something the food industry capitalizes on to sell more snacks and beverages) has stayed with me.

So, back to this “prediabetes”. See what I did there…..used an equivalent of the silly broken leg/cast story and translated it to a field where it’s a bit easier to see the steady progression of a disease process when inadequate, early intervention is ignored. For sure, a broken, but otherwise caries-free, incisor might require a root canal and crown, and it would be foolish to do the same before the injury in order to prevent it…..wear a mouth guard for every hockey or lacrosse game would be the appropriate advice. However, someone who ignores the treatment recommendations as a very early incipient carious lesion ( reversible) progresses through the smaller to larger cavity stages of pre root canal until the time that no other options for restoration exist. That (along with equivalent examples of periodontal disease) is probably the best equivalent of the disease progression under the hood that happens with all the downstream sequelae of the early departure from healthy homeostasis that is occurring in prediabetes. There’s just a better warning for the former…..the bathroom mirror when used critically. Believe it or not (and my retirement portfolio attests…..or it did before the pettyfogging divorce lawyers started dipping their bread) there are folk who exercise the same denialism with what’s visible…..just like the obvious with diabetes and that belly fat. Maybe my argument doesn’t hold up quite so well​:thinking:

Almost forgot….if I failed to alert patients appropriately in all those pre root canal and pre periodontal disease years, I would have found myself sharing my income with the legal profession at a much earlier stage in my life. It would be considered indefensible supervised neglect.

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Ahh, yes, sugar everywhere as a kid, no controls set up, and as I look back, my parents as I knew them, never had teeth! Both full uppers, lowers, maybe to do with coming through the 'depression’ years, but all that happened before my time from the ‘40s onward, so for whatever reason, my dental care, concern was zero, barely remember my early times as far as losing baby teeth, barely remember one dentist visit pre-teen to remove a couple errant snags, then nothing until my teen life of toothaches, temporary fillings, root canals, all fails, again, lack of care through it all, I remember brushing with baking soda in the early days, so maybe part of why I went without brushing a lot… Anyway, eventually better dentists, mercury/silver amalgams gone, one way or another… Caps, bridges, successful root canals, one fairly recent… last year was an expensive series of fixes, prior dentist had apparently ignored #26’s cavity, until a cleaner slipped up, showed me I indeed had a cavity! Bingo, root canal, new bridge! Anyway, full upper, maybe 8 or 10 lower survivors, supporting the bridges or caps… Ahh, gingevectomies, bone grafts, bonding, saving what can be saved…

We made sure our kids went to the dentists regularly, straightened, etc.. We also have been doing quarterly cleanings, and a new dentist now, between the two of us, many $$$’s invested lately.. And those hours in the chair, tough, no matter who the tech or DDS it is… Survival! And at least we can afford the care, some insurance coverage, but lots of out of pocket…

Dental care needed to be taught seriously and early!!