The Ad Council (with pro bono help by the ad agency Ogilvy) has released an admittedly adorable set of ads to encourage people to get tested for prediabetes. I agree with them in principle: testing for prediabetes is cost-effective in the long-term as long as it's paired with a lifestyle program that reduces the risk of advancing to full-blown diabetes:
(mandatory conflict of interest disclosure here: I'm a consultant on a CDC 1422 grant that aims in part to increase screening, detection, and referral of pre-diabetic patients into the Diabetes Prevention Program)
But unfortunately, the "testing" offered in these ads is probably far too sensitive. That is, it picks up too many possible pre-diabetes cases and over-diagnoses people.
The evidence for my contrarian stance is here:
Investigators publishing in JAMA Internal Medicine found that, according to a test very similar to the one in the commercials, almost 60% of patients over age 40 would qualify as "at risk" for pre-diabetes, and 81% (!) of those over age 60 would qualify. These numbers are clearly too high; the total population of pre-diabetic persons in the United States is about 86 million:
That's less than 30% of the population. Yet the puppies-and-hoglets-and-goats test says that almost twice that number is at risk. The United States Preventive Services Task Force, on the other hand, says that testing should be done based on only two factors: age (between 40 and 75) and Body Mass Index (25.0 or above). This is a more reasonable strategy based on risk of heart disease, but it unfortunately misses almost half of cases. Investigators publishing in PLoS Medicine found that, by looking at 1.6 years of electronic health record data from 2008-2010, only 45% of patients ultimately diagnosed with diabetes or prediabetes would have been screened under the USPSTF criteria. 78% of the missed cases would have been missed because they were under age 40, and 29% would have been missed because they were too thin, with a BMI under 25.0.
So what's the answer? The answer is to keep yourself from ever transitioning from "person" to "patient" in the first place. If you think you're at risk, based on the puppies-and-hoglets-and-goats test, a hunch, a past blood test, or a soothsayer, make a change. Jump into a new life and reduce your risk. It'll be cost-effective in its own right: Ride your bike to work. Pledge to eat only food that comes from the produce section without packaging for a month. Go to bed earlier at night. Give up bug juice for good. Make a change. And then, only after you've adopted the life you want and deserve, think about whether or not you want to get tested on your own terms.