More fun can be had with epidemiology than with any other branch of investigation. It’s the only science whose practitioners regularly jump out from behind the bushes yelling Boo! And even though the strolling citizen knows the fright is coming, even though he can see the man in the white frock lurking in the foliage ahead, and even though he has walked past this very spot hundreds of times before, the finale unvarying, he never fails to shriek and cower after the trick is sprung. The citizen stands and delivers, and gratefully, too.
The epidemiologists at the United Health Group have just burst from behind the ornamental barberry with this press release, announcing a new report:
“More than 50 percent of Americans could have diabetes or prediabetes by 2020 at a cost of $3.35 trillion over the next decade if current trends continue.”
More than fifty percent! Boo!
Wait a second. Strike that. Something fishy here. By 2050, forty to fifty percent of all citizens will be under 30 years of age. This of course implies that fifty to sixty percent will be 30 or older. Now, type 2 diabetes is a disease primarily of the old, and while some under 30 may have it, most of those afflicted will be older than 50 or 60.
Thus, taking the United Health Group’s press release at its word tells us that nearly every adult by 2050 will have type 2 diabetes or prediabetes. No Halloween prank was more frightening than a statement like this.
One should never rely on press releases, whose prose sinks below even advertising copy in reliability. Let’s examine what the actual report said:
“The United States of America is on track to become the United States of Diabetes. The epidemic of type 2 diabetes and its warning sign, prediabetes, is sweeping across the country. By 2020, an estimated 52 percent of the adult population will have diabetes or prediabetes.”
Fifty-two percent! Boo! More than half the citizens of the good ol’ USA will have type 2 diabetes, a horrible disease!
Wait a second. Strike that. A closer reading reveals that everybody won’t fall prey to type 2 diabetes, but also to the strange malady called prediabetes. In technical terms, and according to our watchful government, prediabetes “means your blood glucose is higher than normal but lower than the diabetes range.”
Thus, in plain English, prediabetes translates to not-diabetes. With this definition in mind, we can see that the statisticians at United Health have grossly underestimated the number of adults living with type 2 diabetes or prediabetes. That number won’t be fifty-two percent, but will be roughly double that, a truly startling number.
Isn’t having blood glucose higher than normal but lower than a diabetes a bad thing? Well, no, not really. It is true that those who have diabetes started with blood glucose levels lower than diabetes levels yet higher than normal. But it is also true that many of those who have blood glucose levels lower than diabetes levels yet higher than normal never develop diabetes. For them, life is sweet.
The best way to state this is that those in the “normal” range are at lower risk of developing diabetes than those in the higher than normal range. And let’s not forget the crucial addendum: whoever is at risk from the disease does not have the disease. Being “at risk” is not equivalent to “having” a disease.
To risk tediousness, let’s restate the fact that prediabetes means not-diabetes. Therefore, what is the use of forecasting an increase in prediabetes rates? Except to needlessly frighten, there is no good reason at all, especially if you are simultaneously forecasting actual diabetes rates.
Just think. The population in 2050 will consist of three subpopulations: diabetes free, prediabetes, and diabetes. The first two subpopulations do not have diabetes. Stated another way, they are healthy. The prediabetes folks are not diabetics. If they were diabetics—I cringe stating something this obvious—then they would be in the diabetic group and not in the prediabetes group.
We know United Health’s purpose is to frighten—in modern parlance, “raise awareness”—because they make of point of saying, “The vast majority of people with prediabetes (more than 90 percent) and about a quarter of people with diabetes are unaware of their health condition.” The “health condition” of prediabetics is properly classed, as we have seen, as healthy. Yet they are recommending people be drug into doctors’ offices so that they can be informed of their “condition.” Baring hypochondriacs, most healthy people are aware of their health, so that this exercise would be pointless.
These kinds of reports invariably raise my blood pressure, which I just checked: 125 over 80. That puts me in the “prehypertensive” category, defined as those people who don’t have hypertension (high blood pressure) but someday might have it. I’d better get to a doctor right away!