The Day the Screening Sirens Cried Wolf

The Day the Diabetes Sirens Cried Wolf, a look at our Desensitization to Prediabetes

Growing Desensitization to Prediabetes

When I think of desensitization, I think of allergies. I picture a child who is administered a gradually increasing dose of a substance he is allergic to, much in the same way allergy shots are given. Slowly, the child’s body learns to become less reactive to the exposure. He grows less sensitive- a desensitization.

With similar methodology to that described above, doctors in this country are becoming desensitized. Not to allergy shots, per se, but to results. Our allergy shot equivalent is the abnormal diabetic screen- the result we receive when we screen for diabetes. We have essentially become numb to the range that hovers between 5.7 and 6.4- the Prediabetes phase.

The Rise of PreDiabetes

I came up with the analogy, comparing doctors’ reactions to a ‘desensitization’, after a discussion with a friend over dinner just the other day. She revealed to me, over a bowl of greens and a side of vegetables, that her own Hemoglobin A1C value had been elevated to prediabetic levels, during several different blood draws. What concerned her was that her own physician had, in fact, not touched on this as much as she thought he would. Not a big deal, she was essentially told. He had pooh-poo’ed the numbers, a response equivalent to a dismissive wave of the hand.

Hemoglobin A1C, for those who may not know, is a measure of the average past 3 months of blood sugar concentrations. It is obtained by a simple blood test.

It got me thinking about my own office’s abnormal A1C values. I see them all the time. Not the kind that define diabetes, above the 6.5 range- those appropriately result in a knee-jerk haste for rapid change, perhaps following an initial grimace of surprise or timely look of horror, worn on the faces of both patient and physician. What I do see a lot of are the kind that come before- that gray zone we call impaired glucose tolerance, or prediabetes- values between 5.7 and 6.4. It is a finding that should ring bells, set off alarms, like the harsh sound of the siren which blasts through the sky before hurricanes make landfall.

Take cover,” the siren screeches, and naturally, people scramble to find shelter.  But unfortunately, the siren of prediabetes hardly has the same effect. If only patients realized what Hurricane Diabetes was truly capable of! They name hurricanes these days, right? The havoc wreaked by this storm can be devastating- I see it on a regular basis in my office alone. But as for the hurricane warnings- why are we as physicians spending less of our time asking people to run to their shelters?

(Prediabetes) is a finding that should ring bells, set off alarms, like the harsh sound of the siren which blasts through the sky before hurricanes make landfall.

The sad reality of this day and age is that, with the alarming rates of obesity in this country alone, we see these numbers all the time. I’d estimate that at least 50% of my patients, who are not diabetic, are in this range. On reading on the topic, I found a publication in the journal Diabetes Care from 2010, which found that 34% of subjects studied had Impaired Glucose Tolerance (the equivalent of prediabetes) using a cross-sectional survey, and, while that number sounded alarming, I guessed that, only one decade later, that rate had risen.

I decided to seek out more updated numbers so I set out on an easily-accessible Google search and found a 2017 National Diabetes Statistics Report from the CDC which reported back on data from the last several years. It was alarming, to say the least. It estimated that, in 2015, 34% of U.S. adults aged 18 years or older (or 84.1 million people) had prediabetes, based on their fasting glucose or A1C level, while nearly half (48.3%) of those aged 65 years or older had the same numbers.

That’s when it hit me. We are desensitized, as medical practitioners, to impaired glucose levels. The upward trend in abnormal numbers is occurring at such alarming rates that doctors are growing used to seeing them, and not focusing on the necessary change. Results are essentially ‘crying wolf’ and the doctor is no longer impressed.

We have become numb to prediabetes.

Why We May Be Growing Numb

I think of my own practice, and to my interactions with patients who need to work on their lifestyle to improve numbers. It’s a difficult discussion to have. I meet a lot of resistance. I know that part of the problem is that it’s just not easy to make changes. We tend to gravitate towards habits that satisfy cravings, like eating greasy foods or spending an afternoon in sedentary heaven. Just think of the front end of a convenience store and you have living proof of this concept. Conveniently packed in those front-end shelves are the sticks of gum, wrapped candy bars, and bags of chips. All junk, all meant to satisfy last minute cravings as you head out the door. I have yet to wait in a grocery store line and peruse through a last minute selection of fruit, glaring invitingly up at me from the rows.

We may also just not have the time. Let’s fact it- the practice of medicine has tasted a sip of Alice’s Drink Me Potion, as visits shrink shorter and shorter in length. We scramble through findings, through paperwork, and through clicks, ensuring all boxes are checked off for credit, often at the expense of valuable counseling time. The topic is, often times, brushed over, as we focus on other, more pressing matters at hand. Those abnormalities are often the ones which the patient may feel more motivated to change- the ones he feels warrant the face-to-face, co-pay-worthy time at his shrunken down doctor’s appointment.

There’s usually so much to talk about, because healthy patients are not normally the ones that show up at our office. How many 40 year olds actually come in for visits? Not a majority. I’m lucky if they come in for their annual visits. After that, it’s impossible to get them back in to speak about ‘dietary modifications’. If I told a typical patient to come in just for this, I’d guess they would laugh in my face. We live, after all, in a world of advice-overload. It’s everywhere we turn, at the tips of anyone’s fingers, and available for free.

We tend to gravitate towards habits that satisfy cravings, like eating greasy foods or spending an afternoon in sedentary heaven.

So what do we do about this country’s growing desensitization to prediabetes?

We need to buckle up and address this issue head-on, shaking off the numbness and looking past the repetitiveness of these findings. We need to bring our patients back in and focus on lifestyle, reinforcing the need for dietitians, exercise, and self-awareness. We need to also bring back accountability, not only on the part of the patient, but also on that of the physician. Because our role is to re-sensitize ourselves to the impending dangers, to sound the sirens, and to get our patients the shelter that they need.

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1 Comment

  1. Okay I’ve read this entire article. And I am reminded of the one and only time I took a stress test. I’d been smoking for over 40 years at the time. The technician if that is his title. Told me I needed to quit smoking and lose weight. Probably good advice. But not from a guy twice my weight with a pack of cigarettes in his shirt pocket. On the prediabetes subject. Why are doctors so quick to prescribe and so slow to advise? Don’t tell me I need this or that drug forever. Tell me how to live without it.

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