Who will research diabetes and argan oil?

The most common chronic disease after obesity, afflicting 84 million Americans and more than 1 billion people worldwide, was born as a public relations catchphrase. In 2001, the PR chief of the American Diabetes Association (ADA) approached Richard Kahn, then the group’s chief scientific and medical officer, for help with a vexing problem, Kahn recalls. ADA needed a pitch to persuade complacent doctors and the public to take seriously a slight elevation in blood glucose, which might signal a heightened risk of type 2 diabetes. Raising the alarm wasn’t easy, given the condition’s abstruse name, impaired glucose tolerance, and lack of symptoms.

Kahn invited half a dozen diabetes thought leaders to brainstorm at a National Institutes of Health cafeteria in Bethesda, Maryland. Surrounded by hungry federal employees, many enjoying the kinds of fatty foods and sugary drinks tied to the diabetes epidemic, they landed on a then–little-used term that seemed sure to scare patients and doctors into action: prediabetes.

DUBIOUS DIAGNOSIS

The war on ‘prediabetes’ could be a boon for pharma—but is it good medicine?

KEY TAKEAWAYS
A questionable condition
Sweeping diagnosis In 2004 and 2010, the American Diabetes Association (ADA) expanded the blood sugar range it considers a sign of prediabetes, creating tens of millions of potential patients in the United States. The U.S. Centers for Disease Control and Prevention joined ADA in raising the alarm, portraying the condition as a first step toward frank diabetes.

Little risk Prediabetes does little or no harm on its own, and fewer than 2% of prediabetics in the ADA range progress to diabetes each year. Many studies suggest that for most people the usual treatments for prediabetes, diet and exercise, do little to further reduce the risk of diabetes.

Strong medicine Industry is developing at least 10 classes of drugs targeted to prediabetes. ADA also lists existing diabetes and weight loss drugs as options for people with prediabetes, and doctors are prescribing them “off label.” Many of those drugs can have serious side effects.

Money trails ADA and some of its physician advisers who have discussed drug treatments for prediabetes receive extensive financial support from pharmaceutical companies. The organization and its advisers say the payments have not affected their recommendations.