Adele - there is strong data to show that there is increased health risk with rising blood pressure or increased fasting plasma glucose - hence the definition of the diseases hypertension and diabetes which may not cause a person a problem until the end organ complication occurs.
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Replying to @MichaelMindrum @angryhacademic
This is what I get for tweeting in the grocery store check-out line. It's the cut-points that are speculative, not the overall natural history of the disease that ultimately results in organ damage. Those goalposts have been moved several times and 1/2
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it is not clear whether lowering these cut-points (the goalposts move ever closer to what was formerly "normal," not in the other direction, that I am aware of) improves "prevention" or just increasingly medicalizes us so that everyone is "pre-" something.
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Replying to @ahhite @angryhacademic
thanks Adele - agree. As far as the recent hypertension story I think the pharmaceutical forces overstepped in trying to capture a larger population and glad that there was loud pushback.
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As far as diabetes goes, spoke recently to some of the people responsible for identifying the HbA1c guidelines. "Diabetes" cutoff was based primarily on appearance of retinopathy and peripheral neuropathy, "pre-diabetes" on macrovascular complications
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Replying to @GidMK @MichaelMindrum and
...as well as risk of developing diabetes. However, there's some debate currently as to whether 5.7% cutoff for pre diabetes is correct, given that few people between 5.7-6 develop significant complications/diabetes
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Replying to @GidMK @MichaelMindrum and
Good chance the pre- diabetes cutoff will be raised to 6 in the next year or two, watch this space!
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That would be a first, maybe? Moving the goalposts away from "normal"?
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Not sure of other examples, there may be some, but the argument is that there's no utility to having the cutoff set at 5.7, setting it at 6 allows us to better target people in need, and those who are 5.7-5.9 are at a very low risk anyway
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pre-DM criteria is currently 6.1 to 6.4 for A1c, 6.1 to 7 for FPG. <5.7 may be "optimal". T2D is heterogenous but pre-DM even more so -- some pre-DM resolve on own but others sinisterly progress w/ ongoing loss of beta-cells.
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Depends on whether we're using the European or American criteria
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